• Romain Touzé, Bastien Gravellier, Claudia Rolla-Bigliani, Valérie Touitou, Eimad Shotar, Stéphanie Lenck, Anne-Laure Boch, Vincent Degos, Nader-Antoine Sourour, and Frédéric Clarençon.
• Interventional Neuroradiology Unit, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
• Neurosurgery. 2020 Apr 1; 86 (4): 455-463.

BackgroundFlow-diverter stents (FDSs) have recently gained acceptance for the treatment of intracranial aneurysms, especially for carotid-ophthalmic aneurysms (COAs). However, complications have been reported after coverage of side branches, especially the ophthalmic artery (OA).ObjectiveTo evaluate, through a meta-analysis, the occlusion rate, and the ophthalmic complications after treatment of COA by FDS.MethodsWe reviewed on MEDLINE via PubMed, Embase via Ovid, and Cochrane central database via CENTRAL. We included all case series with at least 15 patients and clinical trials about flow diversion of aneurysms close to the OA's origin. Among these studies, we only included articles with aneurysm occlusion rate and rate of new ophthalmic symptoms.ResultsWe included 16 studies with 913 COA treated by FDSs and covering the OA with a mean follow-up of 16.4 mo. The random-effect modeling analysis concerning the overall rate of new ophthalmic complications, after FDS deployment covering the OA, was 3.0% (CI95% 1.0-6.0). There was medium-high heterogeneity in the study reports P < .01, I2 = 70.2% [50.4%; 82.1%]. We were not able to statistically explain this heterogeneity with the performed analysis, which could be related to the design of the included studies. We found an overall aneurysm occlusion rate of 85.0% (95% CI 80.0-89.0).ConclusionOur meta-analysis found a high aneurysm occlusion rate (85%) and low rate of iatrogenic visual complications, with only 3.0% of new visual symptoms, after treatment of COA by FDS.Copyright © 2019 by the Congress of Neurological Surgeons.

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