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Long-term outcomes of flow diversion for unruptured intracranial aneurysms: a systematic review and meta-analysis
  1. Mostafa A Shehata,
  2. Mohamed K Ibrahim,
  3. Sherief Ghozy,
  4. Cem Bilgin,
  5. Mohamed Sobhi Jabal,
  6. Ramanathan Kadirvel,
  7. David F Kallmes
  1. Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Mostafa A Shehata, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; shehata.mostafa{at}


Background Flow diverters have been widely used in clinical practice for more than a decade. However, most outcome data are limited to 1 year timepoints. This study aims to offer meta-analysis data on long-term (>1 year) safety and effectiveness results for patients with aneurysms treated with flow diverters.

Methods PubMed, Web of Science, Embase, and SCOPUS were searched up to February 24, 2022 using the AutoLit platform. We included primary studies assessing the long-term outcomes for flow diverter devices to manage unruptured internal carotid artery aneurysms with a follow-up period of >1 year. The meta-analysis was carried out using Comprehensive Meta-Analysis software (CMA).

Results Eleven studies were included in the meta-analysis. The pooled occlusion rates after flow diversion treatment for unruptured intracranial brain aneurysms were 77%, 87.4%, 84.5%, 89.4%, 96% for 1 year, 1–2 years, 2 years, 3 years, and 5 years follow-up, respectively. The in-stent stenosis rate was 4.8% and the retreatment rate for the long-term follow-up period was 5%. No delayed rupture of the aneurysm was reported, and there was one case of delayed ischemic stroke. The sensitivity analysis of the prospective studies showed a complete occlusion rate of 83.5% and 85.2% for 1 and 3 years of follow-up, respectively.

Conclusion Flow diverters are safe and effective in short- and long-term follow-up and rarely cause serious delayed side effects.

  • aneurysm

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  • MAS, MKI and SG are joint first authors.

  • Twitter @khaledorad, @SobhiJabal

  • Contributors All authors contributed to the study design and drafting of the manuscript. The search was completed by MAS and MSJ, screening of articles by MAS and CB, data extraction by MAS and MKI with quality control by MAS, MKI, and SG. Statistical analysis was provided by MAS and SG. All authors contributed to feedback and finalization of the manuscript.

  • Funding This study was in part supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number R01 NS076491 and R43 NS110114.

  • Competing interests DFK holds equity in Nested Knowledge, Superior Medical Editors, and Conway Medical, Marblehead Medical; is a consultant for MicroVention, Medtronic, Balt, and Insera Therapeutics; Data Safety Monitoring Board for Vesalio; and receives royalties from Medtronic. RK reports NIH funding (R01 NS076491, R43 NS110114, and R44 NS107111), is a research consultant for Cerenovus, Insera Therapeutics, Marblehead Medical, Microvention, MIVI Neuroscience, Neurogami Medical, and Triticum, and has stock in Neurosigma (money paid to institution).

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.