Flow diverter with or without adjunctive coils in the treatment of large and giant intracranial aneurysms: a meta-analysis

To evaluate the available evidence on the efficacy and safety of flow diverters (FD) with or without adjunctive coils (C) for the treatment of large and giant aneurysms. A systematic review and meta-analysis of relevant studies in PubMed and selected articles up to December 2022 were conducted. The primary objective was to evaluate the rate of favorable occlusion O’Kelly Marotta (OKM) C-D at the last follow-up, while the secondary objective was to assess complication rates. A fixed-effects model was used, and relative risks (RR) and 95% confidence intervals (CI) were calculated. A total of 146 articles were identified, but only 10 were included in the meta-analysis. This included 541 controlled aneurysms out of a total of 680 large and giant aneurysms from 1,667 patients. We found no statistical differences in favorable OKM C-D outcomes with or without the adjunctive use of coils (RR 1.06 [0.96, 1.17]; p = 0.280). However, FD + C presented fewer complications (RR 0.56 [0.33, 0.95]; I²=0%; p = 0.03). No statistical differences were found for mortality (RR 0.86 [0.34, 2.18]; I²=0%; p = 0.75). The use of adjunctive coils during treatment of large and giant aneurysms with FD seems to reduce the risk of procedural and delayed complications, while it does not increase the aneurysm occlusion rate.