Comparison of flow diverters versus stent-assisted coiling in unruptured anterior circulation bifurcation aneurysms: a two-center, propensity score matched study.

backgroundStent-assisted coiling (SAC) and flow diverters (FDs) are common endovascular treatments for intracranial bifurcation aneurysms. However, studies comparing FDs and SAC were scarce. Thus, we performed a two-center, propensity score matched (PSM) cohort study to compare the FDs and SAC devices for intracranial bifurcation aneurysms.

methodsConsecutive patients with intracranial bifurcation aneurysms were treated with FDs or SAC at two advanced stroke centers were enrolled in the study. Propensity score matching (PSM) was employed to adjust for demographic and aneurysm characteristics. The perioperative and midterm follow-up outcomes were compared between the two devices.

resultsA total of 131 patients with 131 intracranial bifurcation aneurysms were included. After PSM, 66 aneurysms treated with the FDs and SAC were matched (n = 33 in each group). At a median follow-up of 6-7 months, significant differences were observed in procedure time (105.00 min vs. 155.00 min, p < 0.001), rate of complete aneurysm occlusion (60.6% vs. 93.9%, p = 0.001) between the FDs and SAC group. There were no statistical differences in total perioperative complications (3.0% vs. 9.1%, p = 0.302), in-stent stenosis (9.1% vs. 9.1%, p = 1.000), device-related challenges (3.0% vs. 6.1%, p = 0.555) and follow-up mRS score of 3-5 (3.0% vs. 3.0%, p = 1.000) between the FDs and SAC group.

conclusionCompared with SAC, FDs provide a comparable rate of perioperative and clinical outcomes in unruptured intracranial bifurcation aneurysms. Nevertheless, a better occlusion status in the SAC group needs to be further verified over a longer follow-up period.