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Treatment of posterior circulation non-saccular aneurysms with flow diversion versus stent-assisted coiling: a systematic review and meta-analysis
  1. Ricardo A Domingo1,
  2. Shashwat Tripathi2,
  3. Carlos Perez-Vega3,
  4. Tito Vivas-Buitrago1,
  5. Victor M Lu4,
  6. Nathan D Todnem1,
  7. Alfredo Quinones-Hinojosa1,
  8. Rabih G Tawk1
  1. 1 Neurosurgery, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
  2. 2 Mathematics, University of Texas System, Austin, Texas, USA
  3. 3 School of Medicine, Monterrey Institute of Technology and Higher Education - Mexico State Campus, Guadalajara, Mexico
  4. 4 Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Rabih G Tawk, Neurosurgery, Mayo Clinic Hospital Jacksonville, Jacksonville FL 32224, Florida, USA; tawk.rabih{at}


Treatment of non-saccular aneurysms of the posterior circulation poses a great challenge with unpredictable outcomes due to the absence of a true aneurysm neck and the presence of perforating vessels. In this article, we aim to compare endovascular treatment of unruptured posterior circulation non-saccular aneurysms with stent-assisted coiling (SAC) and flow diversion (FD) in terms of occlusion rate and clinical outcomes. A systematic search of electronic databases from inception to August 2019 identified 484 articles for screening. After proper inclusion/exclusion criteria, 15 articles were included and data were extracted and analyzed using meta-analysis of proportions. The pooled cohort consisted of 430 aneurysms: 128 (29.7%) treated with SAC in 5 studies and 302 (70.3%) treated with FD in 11 studies. Complete/near-complete occlusion was achieved in 83% after FD (95% CI 0.75 to 0.90; I2=45%) and 84% after SAC (95% CI 0.72 to 0.91; I2=22%), with no significant difference between techniques (p=0.95). Periprocedural complications were observed in 18% after FD (95% CI 0.14 to 0.23; I2=0%) and 6% after SAC (95% CI 0.02 to 0.13; I2=0%); the subgroup analysis was statistically significant (p=0.008). Furthermore, no statistically significant difference was observed in favorable clinical outcomes between groups. These results suggest similar efficacy in occlusion rate and favorable clinical outcome for posterior circulation non-saccular aneurysms treated with SAC and FD. Stroke was the most common complication regardless of treatment modality, and a lower periprocedural complication rate was noted with SAC. Further studies are needed with the primary focus of reducing the risk of stroke with either modality.

  • aneurysm
  • flow diverter
  • stent
  • coil
  • stroke

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  • Contributors All clinical investigators involved met the criteria for authorship. RAD: planning, conduct, reporting, conception and design, acquisition of data and interpretation of data. ST: planning, conduct, conception and design, analysis of the data and interpretation of the data. CP-V: conduct, conception, acquisition of data. TV-B: interpretation of data, conception, critical review. VML: analysis of the data and interpretation of the data, critical review. NDT: supervision, critical review. AQ-H: supervision, critical review. RGT: planning, conduct, reporting, conception and design, interpretation of data, supervision, critical review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.