Flow-Diversion Treatment of Unruptured Saccular Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis.

Cagnazzo, F; Limbucci, N; Nappini, S; Renieri, L; Rosi, A; Laiso, A; Tiziano di Carlo, D; Perrini, P; Mangiafico, S

BACKGROUND Flow diversion for anterior communicating artery aneurysms required further investigation. PURPOSE Our aim was to analyze outcomes after treatment of anterior communicating artery aneurysms with flow-diverter stents. DATA SOURCES A systematic search of 3 data bases was performed for studies published from 2008 to 2018. STUDY SELECTION According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting anterior communicating artery aneurysms treated with flow diversion. DATA ANALYSIS Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and factors influencing the studied outcomes. DATA SYNTHESIS We included 14 studies and 148 unruptured saccular anterior communicating artery aneurysms treated with flow diversion. The long-term complete/near-complete (O'Kelly-Marotta C-D) occlusion rate was 87.4% (91/105; 95% CI, 81.3%-93.6%; I2 = 0%) (mean radiologic follow-up of 11 months). The treatment-related complication rate was 8.6% (14/126; 95% CI, 4%-13.1%; I2 = 0%), with morbidity and mortality rates of 3.5% (5/126; 95% CI, 2%-7%; I2 = 0%) and 2.5% (2/148; 95% CI, 0.3%-5%; I2 = 0%), respectively. Most complications were periprocedural (12/126 = 7%; 95% CI, 3%-11%; I2 = 0%). Thromboembolic events were slightly higher compared with hemorrhagic complications (10/126 = 6%; 95% CI, 2%-10%; I2 = 0% and 4/126 = 3%; 95% CI, 1%-6%; I2 = 0%). Branching arteries (A2 or the recurrent artery of Heubner) covered by the stent were occluded in 16% (7/34; 95% CI, 3.5%-28%; I2 = 25%) of cases. Pre- and posttreatment low-dose and high-dose of antiplatelet therapy was not associated with significantly different complication and occlusion rates. LIMITATIONS We reviewed small and retrospective series. CONCLUSIONS Flow diversion for unruptured saccular anterior communicating artery aneurysms appears to be an effective alternative treatment for lesions difficult to treat with coiling or microsurgical clipping. The treatment-related complication rate was relatively low. However, larger studies are needed to confirm these results.