Patency of the supraclinoid internal carotid artery branches after flow-diversion treatment. A meta-analysis

Abstract

Placement of flow diverters across the ostia of major ICA branches carries a risk of arterial occlusion. We determined the rate of occlusion of the supraclinoid ICA branches and the related symptoms, following coverage with flow diverters. A systematic search was performed in PubMed, MEDLINE, and EMBASE. We selected studies reporting treatments with flow diverters in which the device was placed across the ostium of the OphtA, PcomA, or AchorA. Random-effects meta-analysis was used to pool the following outcomes: rate of arterial occlusion, diminished flow, incidence of related symptoms, factors associated with arterial occlusion. Twenty-one studies evaluating 1152 supraclinoid ICA branches were included in the meta-analysis. The incidence of OphtA occlusion and associated symptoms was 5.9% (95%CI = 3.1–8.6%), and 0.8% (95%CI = 0.1–1.4%), respectively. Although asymptomatic in all cases, PcomA showed a higher occlusion rate (20.7%, 95%CI = 8.9–32.4%). AchorA was occluded in 1% (95%CI = 0.3–2.4%) of cases, with approximately 1% (95%CI = 0.4–2.3%) of transient neurological symptoms. There was a trend toward higher odds of arterial patency among arteries arising from the aneurysm (OR = 2.94, P = 0.06). Demographic factors and multiple stents were not associated with higher risk of arterial impairment. Adequate collateral circulation was reported in 94.5% of patients with arterial occlusion. During aneurysm treatment, the ostium of the supraclinoid ICA branches can be covered with flow-diverter devices with low rates of neurological symptoms related to arterial occlusion.