Flow-diverter performance “comparable” between PComAs and other supraclinoid aneurysms

Santiago Ortega-Gutierrez

The concluding findings of a systematic review and meta-analysis published in the journal Neurosurgery indicate that flow-diverter performance in posterior communicating artery (PComA) aneurysms is “comparable” to the outcomes observed in other supraclinoid aneurysm subtypes.

Authors Santiago Ortega-Gutierrez (University of Iowa Hospitals and Clinics, Iowa City, USA) et al note that effectiveness was “acceptable” and safety was “favourable” in their analysis of the existing literature in this space.

“However, effectiveness was suboptimal in patients with foetal-type PComAs; alternative treatments should be considered in these cases,” they add.

The authors preface their report by noting that, while flow diverters have demonstrated a safe and effective profile overall, their use in PComA aneurysms “remains controversial”—leading them to evaluate flow-diverter use in these case types via a systematic review and meta-analysis.

A search from inception to June 2022 was performed for flow diversion in PComA aneurysms. The researchers’ primary effectiveness measure was the rate of complete aneurysm occlusion (Raymond-Roy occlusion classification [RROC] 1), with primary safety outcomes being a composite of treatment-related ischaemic/haemorrhagic events causing morbidity and mortality. PComA patency at follow-up was also among the review’s secondary safety measures.

A total of 13 studies including 397 patients (mean age=48 years) with 403 aneurysms (mean size=5.3mm) were included in the analysis. According to the authors, the majority of these aneurysms (65%) were unruptured. Regarding the key effectiveness metric, complete occlusion at final follow-up was 73%. The authors further report that adjunctive coils were used in 10% of aneurysms and that the retreatment rate was 2%.

The primary safety composite outcome was 4% and mortality was 1%, while PComA patency at final follow-up was 76%. Finally, as per subgroup analyses, patients with foetal PComAs had a lower complete occlusion rate (42%) than those with non-foetal PComAs (77%)—leading the authors to conclude that alternative treatments “should be considered” in these cases.


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