• Juan Vivanco-Suarez, Aaron Rodriguez-Calienes, Peter T Kan, Ajay K Wakhloo, Vitor M Pereira, Ricardo Hanel, Demetrius Klee Lopes, Milagros Galecio-Castillo, Susan Anil, Mudassir Farooqui, Ajit S Puri, and Santiago Ortega-Gutierrez.
• Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City , Iowa , USA.
• Neurosurgery. 2023 Oct 1; 93 (4): 764772764-772.

BackgroundFlow diverters (FDs) have demonstrated a safe and effective profile. However, the use of FDs for posterior communicating artery (PComA) aneurysms remains controversial.ObjectiveTo evaluate the safety and effectiveness of FDs for PComA aneurysms using a systematic review and meta-analysis of the literature.MethodsWe performed a systematic search from inception until June 2022 for flow diversion in PComA aneurysms. Primary effectiveness was the rate of complete aneurysm occlusion defined by Raymond-Roy class 1. Primary safety outcomes were treatment-related ischemic/hemorrhagic (composite) events causing morbidity and mortality. Secondary safety was PComA patency at follow-up. Random-effects meta-analyses were used to calculate proportions, and statistical heterogeneity was assessed.ResultsA total of 13 studies with 397 patients harboring 403 aneurysms were included. Mean age was 48 years, and the mean aneurysm size was 5.3 mm. Most aneurysms were unruptured (65%). Complete occlusion at final follow-up was 73% (CI 66%-79%), and adjunctive coils were used in 10% of aneurysms. Retreatment rate was 2% (CI 0%-9%). The primary safety composite outcome was 4% (CI 3%-7%), and mortality was 1%. PComA patency at final follow-up was 76% (CI 57%-89%). Subgroup analysis, patients with fetal PComAs had a lower complete occlusion rate (42% fetal PComA vs 77%, psubgroupdifference = <.01).ConclusionThe performance of FDs in PComA aneurysms is comparable with outcomes found in other subtypes of supraclinoid aneurysms. Effectiveness was acceptable and safety favorable. However, effectiveness was suboptimal in patients with fetal-type PComAs; alternative treatments should be considered in these cases.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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