Introduction Endosaccular coiling (EC) remains a gold standard treatment for small saccular aneurysms of anterior circulation (AC), however, flow diversion (FD) offers a reasonable alternative. Currently, the benefits of FD in such lesions are not well-established.

Aim of Study To compare safety and efficacy of FD versus EC in small saccular AC aneurysms, amenable to both methods.

Methods In 2016–2019, 344 consecutive cases (FD n=154, EC n=190) were enrolled. All lesions were saccular, sized ≤14 mm, located at intradural ICA or A1/M1, and untreated. Median aneurysm size was 6.6 mm (90% <10 mm), median neck diameter – 3.7 mm (72% wide-necked). Follow-up DSA available for 94.2% cases at median 9 months.

Results In raw cohorts FD vs EC demonstrated Raymond-Roy (RR)-1 occlusion 76.4% vs 53.2% (p<0.0001), RR1+2 – 80.6% vs 69.7% (p=0.033), retreatment – 2.6% vs 15.4% (p<0.0001), all-cause adverse events 12.6% vs 23.6% (p=0.02). In matched cohorts (67 cases each, PS difference ≤0.1 probit SD all covariates) FD vs EC exhibited RR1 occlusion – 80.3% vs 49.2% (p<0.0002), RR1+2 – 80.3% vs 63.1% (p=0.034), all-cause adverse events 17.9 vs 34.3% (p=0.033), retreatment – equal 1.5%. Rates of neurological complications, morbidity, and mortality were similar between groups in both raw and matched cohorts.

Conclusion In both raw and matched cohorts, FD had significantly higher rate of target aneurysm obliteration and lower rate of all-cause adverse events, with similar rates of neurological complications, morbidity, and mortality.

Disclosure of Interest No conflict of interests