Flow diverter treatment for saccular unruptured intracranial aneurysms: a systematic review focussing on study quality and initial outcomes
Introduction: Flow-diverting (FD) stents are increasingly used to treat small, unruptured intracranial aneurysms (UIA), but high-quality, unbiased data on initial complications and clinical outcomes were limited in previous literature reviews. We updated the literature review to assess quality, pote...
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| Main Authors: | , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
September 9, 2025
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| In: |
European stroke journal
Year: 2025, Pages: 1-8 |
| ISSN: | 2396-9881 |
| DOI: | 10.1177/23969873251370992 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1177/23969873251370992
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| Author Notes: | Fabian Wenz, Tamara Wiedemann, Gabriel JE Rinkel and Nima Etminan |
| Summary: | Introduction: Flow-diverting (FD) stents are increasingly used to treat small, unruptured intracranial aneurysms (UIA), but high-quality, unbiased data on initial complications and clinical outcomes were limited in previous literature reviews. We updated the literature review to assess quality, potential bias, complications and short-term outcomes in studies on FD-stents for UIAs. - Patients and methods: We systematically searched PubMed, Embase and Cochrane Library until January 9, 2025 for studies on FD-stents for UIAs. We assessed methodological quality using the methodological index for non-randomised studies (poor: 0-9, moderate: 10-13, good: 14-16), and financial conflicts of interest. The primary outcome was neurological outcome according to a validated outcome scale at 1-3 months after treatment. Secondary outcomes were clinical worsening and complications. - Results: We included 13 studies with 743 patients and 806 UIAs, of which 88.4% (95% CI: 85.7%-91.2%) were <10 mm. All studies were uncontrolled. The methodological quality was poor in six and moderate in seven studies. Financial conflicts of interest were reported in six studies. At 1-3 months after treatment, the proportion of patients were for mRS ⩾1 13.3% (95% CI: 10.0%-16.6%), mRS ⩾2 5.3% (95% CI: 3.2%-7.5%), mRS ⩾3 2.4% (95% CI: 0.1%-3.9%) and neurological worsening 3.1% (95% CI: 1.5%-4.6%). Complications within 3 months occurred in 12.7% (95% CI: 10.3%-15.0%). - Discussion and conclusion: The literature on FD-stents is methodologically weak and potentially biased by financial interests but still shows relevant proportions of complications and post-treatment morbidity. Currently, there are no good data supporting the use of FD-stents for UIAs where standard treatment options are available. Randomised-controlled trials are needed to compare safety, efficacy and durability between FD-stents and coiling or clipping. |
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| Item Description: | Gesehen am 03.11.2025 |
| Physical Description: | Online Resource |
| ISSN: | 2396-9881 |
| DOI: | 10.1177/23969873251370992 |