Treatment of posterior circulation non-saccular aneurysms with flow diversion versus stent-assisted coiling: A systematic review and meta-analysis

Ricardo A. Domingo, Shashwat Tripathi, Carlos Perez-Vega, Tito Vivas-Buitrago, Victor M. Lu, Nathan D. Todnem, Alfredo Quinones-Hinojosa, Rabih G. Tawk

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


Treatment of non-saccular aneurysms of the posterior circulation poses a great challenge with unpredictable outcomes due to the absence of a true aneurysm neck and the presence of perforating vessels. In this article, we aim to compare endovascular treatment of unruptured posterior circulation non-saccular aneurysms with stent-assisted coiling (SAC) and flow diversion (FD) in terms of occlusion rate and clinical outcomes. A systematic search of electronic databases from inception to August 2019 identified 484 articles for screening. After proper inclusion/exclusion criteria, 15 articles were included and data were extracted and analyzed using meta-analysis of proportions. The pooled cohort consisted of 430 aneurysms: 128 (29.7%) treated with SAC in 5 studies and 302 (70.3%) treated with FD in 11 studies. Complete/near-complete occlusion was achieved in 83% after FD (95% CI 0.75 to 0.90; I 2 =45%) and 84% after SAC (95% CI 0.72 to 0.91; I 2 =22%), with no significant difference between techniques (p=0.95). Periprocedural complications were observed in 18% after FD (95% CI 0.14 to 0.23; I 2 =0%) and 6% after SAC (95% CI 0.02 to 0.13; I 2 =0%); the subgroup analysis was statistically significant (p=0.008). Furthermore, no statistically significant difference was observed in favorable clinical outcomes between groups. These results suggest similar efficacy in occlusion rate and favorable clinical outcome for posterior circulation non-saccular aneurysms treated with SAC and FD. Stroke was the most common complication regardless of treatment modality, and a lower periprocedural complication rate was noted with SAC. Further studies are needed with the primary focus of reducing the risk of stroke with either modality.

Original languageEnglish (US)
Pages (from-to)159-163
Number of pages5
JournalJournal of neurointerventional surgery
Issue number2
StatePublished - Feb 1 2021


  • aneurysm
  • coil
  • flow diverter
  • stent
  • stroke

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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