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

Abstract

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 (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. Abbreviations: CE = coil embolization, CI = confidence intervals, FDD = flow-diverting device, HR = hazard ratios, IA = intracranial aneurysm, OR = odds ratio.