Flow-diverting device versus coil embolization for unruptured intracranial aneurysm A meta-analysis

Background: Both coil embolization (CE) and flow-diverting device (FDD) placement are widely used for treatment of intracranial aneurysms (IAs). The aim of this meta-analysis is to compare the relative clinical safety and efficacy of FDD and CE for the treatment of unruptured IAs. Methods: The PubMed, Embase, and Cochrane Library databases were searched for relevant studies from the date of inception through April 2020. The primary endpoint for this meta-analysis was the 6-month rate of complete occlusion, while secondary endpoints included rates of retreatment, complications, and parental arterial patency. Results: This meta-analysis includes 8 studies, which included 839 total patients that underwent FDD and 2734 that underwent CE. FDD group exhibited a significantly higher pooled 6-month complete occlusion rate (P=.02). The subgroup analysis demonstrated that FDD treatment was associated with significantly higher pooled 6-month complete occlusion rates in patients with large or giant IAs (P<.00001), whereas no differences in 6-month complete occlusion rates were observed between the FDD and CE groups of patients with non-large/giant IAs (P=.83). The pooled retreatment (P=.16) and complication (P=.15) rates were comparable between 2 groups. The CE group exhibited significantly higher pooled parent artery patency rate (P=.01). The funnel plots did not reveal any evidence of publication bias. Conclusions: FDDs can be used to effectively and safely treat large and giant IAs, achieving higher rates of complete occlusion than CE treatment. For non-large/giant IAs, we observed comparable efficacy between FDD and CE treatments.

Automated summary

For the treatment of unruptured intracranial aneurysms (IAs), flow-diverting devices (FDDs) show a relatively higher complete occlusion rate, especially in patients with large or giant IAs. However, for patients with non-large/giant IAs, there is no significant difference in treatment effects between FDD and coil embolization (CE). The retreatment and complication rates are similar between the two treatment methods, but CE treatment has a higher rate of parent artery patency.