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Monday, January 15, 2024
Flow diverters with surface modification in patients with intracranial aneurysms: a systematic review and meta-analysis
Ask your doctor if this intervention guarantees no strokes as a result.
Flow
diverters with surface modification (FDSM) are increasingly used in the
treatment of intracranial aneurysms. We aimed to evaluate the
effectiveness and safety across different devices and antiplatelet
therapies using a systematic review and meta-analysis.
Methods
A
systematic review was performed to identify original studies of ≥10
patients with intracranial aneurysms treated with FDSM from database
inception through August 2023. Primary effectiveness outcome was the
rate of complete aneurysm occlusion at follow-up ≥6 months. Safety
outcomes included ischemic stroke, hemorrhage and in-stent thrombosis,
and were stratified by FDSM devices and antiplatelet therapies.
Certainty of evidence was evaluated following the GRADE approach.
Results
Twenty-seven
studies were included, yielding 2161 patients with 2373 aneurysms.
70.5% of the aneurysms were located on the internal carotid artery
(ICA). 10.3% were acutely ruptured. The complete aneurysm occlusion rate
was 72.3% at follow-up ≥6 months. Sensitivity analysis in the ICA
aneurysm cohort yielded comparable occlusion rates between PED-Shield
(80.4%) and Phenox-HPC (77.5%, P=0.54), but a lower 66.2% rate for FRED-X (P=0.02).
The rate of in-stent thrombosis and stenosis tended to be higher in
Phenox-HPC (3.4%) and FRED-X (4.3%) versus PED-Shield (0.8%, P=0.05).
Conclusions
FDSM
were safe with satisfactory effectiveness for intracranial aneurysms.
More specific investigations are warranted to explore their performance
in aneurysms beyond the ICA and optimal antiplatelet therapy.
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