Systematic Review of Flow Diversion for Giant and Paraophthalmic Aneurysms: Are Additional Coils Necessary

Author(s): Hang Yu, Khunsa Faiz, Sudharsana Rao Ande, Janice Linton, Zul Kaderali, Timo Krings, Jai Shankar

Background: There is limited data regarding the use of flow diversion in treating giant or paraophthalmic aneurysms. It is also unclear whether coiling in combination with flow diversion improves outcomes.

Purpose: To evaluate the efficacy of using flow diverters (FD) with and without coiling for the treatment of intracranial aneurysms, especially in giant and paraophthalmic aneurysms.

Data Sources: Ovid Embase and Ovid Medline

Study Selection: Nine studies with 318 patients and 318 aneurysms were used. All were observational studies with five retrospective and four prospective.

Data Analysis: Studies were analyzed for patient and aneurysm characteristics, procedural details including success rate and complications, and follow-up imaging and clinical outcomes.

Data Synthesis: Procedure-related mortality rate was 3.5% (11/318). 6 months occlusion rate was 79.7% (149/187), 83.3% (5/6) for giant aneurysms, and 100% (8/8) for paraophthalmic aneurysms. There was no significant difference in occlusion rate in FD alone vs. FD with coils (p = 0.90). There did not seem to be a difference in morbidity, mortality, or clinical outcomes between FD alone and FD with coils.

Limitations: Small amounts of studies, heterogeneous study populations and types of aneurysm treated. All the included studies were observational with none having been randomized or including control groups. Significant heterogeneity in reporting outcomes and follow-up data.

Conclusions: Flow diverters alone are an effective way to treat giant and paraophthalmic aneurysms. The use of FD with coils was not shown to be superior to the use of FD alone.