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Original research
Flow diversion for compressive unruptured internal carotid artery aneurysms with neuro-ophthalmological symptoms: a systematic review and meta-analysis
  1. Daniel P O Kaiser1,2,
  2. Ani Cuberi3,
  3. Jennifer Linn1,
  4. Matthias Gawlitza1,2
  1. 1 Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
  2. 2 EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany
  3. 3 Department of Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
  1. Correspondence to Dr Matthias Gawlitza, Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden 01307, Germany; matthias.gawlitza{at}ukdd.de

Abstract

Background Data on the safety and efficacy of flow diverters (FD) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms (NOS) are scarce and comprise mainly small case series.

Methods We performed a search of three databases and included series with ≥10 patients, with unruptured aneurysms of the ICA and NOS, treated with FD. Random-effects analysis of treatment results and safety was performed.

Results A total of 22 studies reporting on 594 patients were included. Pooled proportions of NOS recovery, improvement, transient and permanent worsening were: 47.4% (95% CI 35.0% to 60.1%); 74.5% (95% CI 67.9% to 80.2%); 7.1% (95% CI 3.3% to 14.7%); and 4.9% (95% CI 3.2% to 7.4%), respectively. Rates of complete recovery and improvement in patients with isolated visual symptoms were 30.6% (95% CI 12.5% to 57.7%) and 56.6% (95% CI 42.3% to 69.9%). Isolated oculomotor symptoms recovered completely in 47.8% (95% CI 29.9% to 66.3%) and improved in 78% (95% CI 69.2% to 84.9%). Morbidity occurred in 5% (95% CI 2.8% to 9%) and mortality in 3.9% (95% CI 2% to 7.5%) of patients. An increased likelihood of symptom improvement was observed when treatment was performed early (<1 month) after symptom onset (OR=11.22, 95% CI 3.9% to 32.5%).

Conclusion Flow diversion promotes recovery or improvement of compressive symptoms in a large proportion of patients but is associated with significant rates of morbidity and mortality. Transient and permanent NOS worsening is not uncommon. Early treatment is of utmost importance, as it increases the likelihood of symptom improvement more than 10-fold.

  • Complication
  • Aneurysm
  • Flow Diverter
  • Stent

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @daniel_kaiserMD

  • Contributors DPOK: Acquisition of data, data analysis, critical review of manuscript, approval of manuscript. AC, JL: Critical review of manuscript, approval of manuscript. MG: Acquisition of data, data analysis, drafting of manuscript, critical review of manuscript, approval of manuscript, guarantor of the study.

  • 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 DPOK: Received stents from Phenox for research purposes and funding from the Else Körner Fresenius Center of Digital Health and the Joachim Herz Foundation; has a non-financial research agreement with Brainomix; serves as board member of the German Society of Neuroradiology (DGNR). MG: Consultancy contract with Phenox; proctoring contract with MicroVention; member of the clinical event committee for a study on a flow diverter, sponsored by Microvention; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events by Phenox; received stents from Phenox for research purposes; received funding from the Else Körner Fresenius Center of Digital Health.

  • Provenance and peer review Not commissioned; externally 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.