Stent-Assisted Coil Embolization Versus Flow Diversion in Intracranial Vertebral Artery Dissecting Aneurysms: A Systematic Review and Meta-Analysis

Ribeiro Gonçalves O.; Matheus Pereira da SIlva A.; Lee Han M.; Virgilio Ribeiro F.; Oliveira M.; Reis de Oliveira R.; Vitória Sampaio Sobral M.; Gunkan A.; Yuri Ferreira M.; E. Bocanegra-Becerra J.; Ferreira C.; Gordon D.; Serulle Y.; Langer D. · Neuroradiology (2025) · DOI: 10.1007/s00234-025-03739-2

Resumen

Introduction: Intracranial vertebral artery dissecting aneurysms (IVADAs) represent a rare but challenging condition associated with high morbidity and mortality. In the therapeutic landscape, endovascular interventions such as Flow Diversion (FD) and Stent-Assisted Coiling (SAC) are widely used for the management of IVADAs. The aim of this systematic review and meta-analysis is to compare the clinical outcomes and complications associated with FD and SAC techniques in the endovascular management of IVADAs. Methods: We systematically searched PubMed, Embase, Web of Science and Scopus from inception to December 2024. This meta-analysis included retrospective cohort studies comparing flow diverters versus stent-assisted coiling in patients with IVADAs. The primary outcomes included in-stent stenosis, complete occlusion rates, and modified Rankin Scale (mRS) scores. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Statistical analyses were conducted using R software (version 4.4.0), with risk ratios (RR) and 95% confidence intervals (CI) calculated using the Mantel–Haenszel method. Heterogeneity was assessed using Cochran’s Q test and I2 statistics, with an I2 > 40% considered significant. A leave-one-out analysis was performed to evaluate the influence of individual studies on the pooled estimates. Results: A total of seven non-randomized studies were included in the meta-analysis comprising 649 patients with IVADAs. Long-term complete occlusion rates were similar between FD and SAC (RR 0.99; 95% CI 0.89–1.10; I2 = 0%). Favorable functional outcomes were marginally higher with FD (RR 1.04; 95% CI 1.00–1.10; I2 = 0%). Recurrence (RR 0.36; 95% CI 0.13–1.01; I2 = 0%) and retreatment rates (RR 0.44; 95% CI 0.16–1.17; I2 = 0%) were not significantly different between groups. In terms of safety outcomes, in-stent stenosis rates (RR 1.17; 95% CI 0.47–2.91; I2 = 0%) and complication rates (RR 0.74; 95% CI 0.40–1.35; I2 = 0%) were not statistically significantly different. Risk of bias assessment indicated an overall moderate risk across studies, with no study classified as having a serious risk of bias. Conclusion: In this meta-analysis, FD and SAC demonstrated comparable efficacy and safety profiles in the treatment of IVADAs, with no significant differences in long-term complete occlusion, recurrence, retreatment, in-stent stenosis, or complication rates. In this context, FD is a promising technique to treat IVADAs. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.

Instituciones: Universidad Peruana Cayetano Heredia