Optimizing Middle Cerebral Artery Aneurysm Management: A Comprehensive Pooled Analysis of Flow Diverter Implementation

Introduction: Flow diverters (FD) have emerged as a promising alternative for the treatment of middle cerebral artery aneurysms (MCAAs), offering the potential to optimize management outcomes. We conducted a comprehensive pooled analysis to evaluate the effectiveness and safety of FD implementation in MCAAs.

Methods: We conducted a systematic-review in PubMed, Embase, and Web of Science databases following the PRISMA-guidelines. Eligible studies included four or more patients with MCCAAs treated with FD. Pooled-analysis with 95% confidence intervals was used to assess the effects. Heterogeneity was evaluated using I² statistics and a random-effects model was used. Technical success (adequate FD-placement), complete/near-complete occlusion (Raymond Roy-Classification I/II), good clinical outcomes (modified-Rankin Scale ≤2), need of surgical-retreatment, rupture after FD-placement, complications and mortality were assessed. Complications were divided into major and minor-intraprocedural, total-major, total-minor, and total-complications.

Results: Nine studies, comprising 748 patients, and 772 aneurysms were included. The pooled-analyis of technical success revealed overall rate of 98% (95%-100%, I²=0%), and for complete/near-complete occlusion was 83% (73%-92%, I²=74%). For surgical-retreatment 0% (0%-2%, I²=0%). For rupture after FD-placement 0% (0%-2%, I²=0%). For good clinical outcomes 96% (93%-98%, I²=0%). Regarding complications, minor and major-intraprocedural overall rate was 6% (1%-11%) and 6% (3%-10%, I²=0%), respectively. For total-minor and total-major, 6% (3%-10%, I²=0%) and 13% (8%-17%, I²=45%), respectively. Finally, for total complications was 19% (12%-26%, I²=61%) and mortality 1% (0%-2%, I²=0%).

Conclusion : This comprehensive pooled analysis indicates that FDs hold promise for optimizing MCAAs management. The findings highlight their potential for achieving favorable outcomes with an acceptable safety profile. Further research and clinical application are warranted to continue advancing the management of MCAAs with FDs.