Treatment of Paraclinoid Aneurysms With Stent-Assisted Coiling Versus Flow Diversion Techniques: A Systematic Review and Meta-Analysis.

BACKGROUND

The stent-assisted coiling (SAC) and flow-diverter stent (FDS) techniques are widely used in the endovascular treatment of paraclinoid aneurysms. This article compares the occlusion rate, periprocedural complications, and clinical outcomes of SAC and FDSs.

METHODS

Between January 2010 and December 2020, a systematic search of electronic databases identified 2283 articles for screening. After the application of inclusion and exclusion criteria, data were extracted for a meta-analysis of the proportions.

RESULTS

Of 23 articles containing 4 comparative studies, 27 cohorts were included, and 1208 patients with 1328 aneurysms were analyzed: In 10 cohorts, 381 (28.7%) patients were treated with SAC, whereas in 17 cohorts, 947 (71.3%) patients were treated with FDSs. In the comparative studies, no significance was observed between the 2 treatments. In the pooled cohorts, complete occlusion was achieved in 85% of aneurysms after treatment with FDSs (95% CI: 0.81-0.88, I2 =34.7%) and 76% after treatment with SAC (95% CI: 0.70-0.81, I2 =16.6%); the subgroup analysis was statistically significant ( P =0.003). New visual complications were observed in 5% of the FDS-treated group (95% CI: 0.02-0.09, I2 =76.9%) and in 1% of the SAC-treated group (95% CI: 0.00-0.02, I2 =0%); the subgroup analysis was statistically significant ( P =0.018). Other observational indices, including total procedure-related complications; hemorrhagic, thrombotic, and ischemic complications; permanent morbidities, and favorable neurological outcomes, showed no statistical significance between the groups.

CONCLUSION

Compared with SAC, treatment with FDSs may have a higher complete occlusion rate at follow-up. The similarly low rates for procedure-related complications and permanent morbidities indicate that both treatments are safe. A higher rate of new visual complications was noted in the FDS-treated group. Further research is required for direct comparisons along with a complete ophthalmological examination.