{
  "abstract": "Background Posterior circulation (PC) aneurysms are associated with a higher risk of rupture. Flow diverters (FDs) are widely used for carotid intracranial aneurysms, but their role in PC aneurysms is less established. This meta-analysis examines the available literature on the safety and effectiveness of FDs for PC aneurysms.Method We conducted a systematic search from database inception until October 2024. The primary effectiveness outcome was complete occlusion rate defined by the Raymond-Roy and/or O'Kelly-Marotta scales. Primary safety outcomes included thromboembolic event rates following implantation. Secondary outcomes included procedure-related mortality, good functional outcome (GFO), and retreatment. Pool estimates were calculated using a random-effect model. Subgroup analysis based on morphology and study design was also conducted.Results A total of 42 studies met our inclusion criteria. A total of 1698 patients were treated with FDs for 1760 PC aneurysms. Among these cases, 47.6% were in the vertebral artery. Our pooled overall analysis of complete occlusion rates was 72.73% (P<0.0001; I 2=67.2%), and the pooled thromboembolic events rate following implantation was 11.70% (P<0.0046; I2=70.5%). Additionally, the pooled mortality rate was 8.07% (P<0.0001; I2=61.5%), the retreatment rate was 6.59% (P<0.4260; I2=1%), and the pooled GFO rate was 83.99% (P<0.0001; I2=76%). Subgroup analysis revealed that fusiform-dolichoectatic had a complete occlusion rate of 48.29% (P<0.3223; I2=11.7%).Conclusion FDs for PC aneurysms achieve generally adequate occlusion rates, except in dolichoectatic-fusiform subtypes. Despite achieving adequate occlusion rates, FD use was associated with higher thromboembolic events, mortality, and retreatment rates, which necessitates careful patient selection.",
  "authors": [
    {
      "affiliations": [
        "Neurology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Anderson Brito"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Leonardo Cruz-Criollo"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Milagros Galecio-Castillo"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Jorge Cespedes"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Mario Zanaty"
    },
    {
      "affiliations": [
        "Neurology, Neurosurgery, and Radiology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Edgar A Samaniego"
    },
    {
      "affiliations": [
        "Neurology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Nashwa Abdelhakim"
    },
    {
      "affiliations": [
        "Radiology, Tufts Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Ajay K Wakhloo"
    },
    {
      "affiliations": [
        "Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA"
      ],
      "name": "Ricardo A Hanel"
    },
    {
      "affiliations": [
        "Neurology, Neurosurgery, and Radiology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Santiago Ortega-Gutierrez"
    }
  ],
  "title": "Flow diversion for posterior circulation intracranial aneurysms: a systematic review and meta-analysis",
  "uid": "063863e7-4e60-53bd-ace2-8f16bda38a64"
}