Introduction Intracranial vertebral artery dissecting aneurysms (VADAs) are rare and complex. Treatment strategies remain debated due to the involvement of branching arteries.

Aim of Study This study was conducted to assess the safety and efficacy of flow diversion (FD) compared to alternative methods for VADAs through systematic review and meta-analysis.

Methods In December 2023, we conducted a systematic search in Pubmed, Scopus, and Web of Science following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our objective was to compare occlusion rates, favorable mRS (0-2), and complication rates. Additionally, we directly compared the FD group with other interventions. We employed a weighted random-effect model for meta-analysis.

Results 23 articles and 422 patients were included. The immediate occlusion rate was 5.8% for FD, which is significantly lower than stenting methods (OR= 0.03, P value< 0.0001). The final complete occlusion rate was 79.87% similar to the stenting group (OR= 1.01, P value= 0.98) and lower than deconstructive treatment (OR= 0.16, P value= 0.005). Favorable mRS was recorded in 95.31% which was comparable to the stenting group (OR= 1.57, P value= 0.47), but significantly higher compared to the deconstructive group (OR= 4.27, P value= 0.002). Complication rates were low (9.7%) without a significant difference compared to the other two groups (P value= 0.19, P value= 0.68). Adverse events were reported in 17.3% when the posterior inferior cerebellar artery was covered by FDs.

Conclusion This study highlights FDs as a potentially effective initial treatment choice for VADAs, especially for unruptured cases.

Disclosure of Interest no.