Comparison of Flow-redirection Endoluminal Device and Pipeline Embolization Device in the Treatment of Intracerebral Aneurysms: A Systematic Review and Meta-analysis

Introduction: Flow diverters have been used extensively to treat intracerebral aneurysms. The aim of this study is to compare the efficacy and safety of pipeline embolization device (PED; Medtronic Inc) with flow-redirection endoluminal device (FRED; MicroVention) in treatment of intracerebral aneurysms.

Methods: PubMed, Medline, and Scopus databases were screened for studies comparing PED and FRED for treatment of intracerebral aneurysms. Comparison between interventions was done through obtaining pooled estimates using odds ratio (OR) and a 95% confidence interval (CIs) for each intervention using either random or fixed-effect model based on heterogeneity assessed using Cochran test and I-square statistics.

Results: Five studies were included with a total number of 1106 patients experiencing 1185 aneurysms. Patients’ mean age ranged from 51.7 to 61 years with 65.9% being females. PED was used in 714 patients, while FRED was used in 457 patients with a median follow-up duration between 9 to 13 months. Occlusions were less likely to occur using PED compared to FRED use (OR: 0.52; 95% CI: 0.35-0.78; p=0.001), however, the 6-months occlusion rate was higher in PED use (OR: 2.01; 95% CI: 0.99-4.05; p=0.05). FRED was associated with a higher likelihood of favorable outcomes compared to PED (≤2 Modified Rankin Scale score) (OR: 2.56; 95% CI: 1.65-3.99; p< 0.0001). Use of PED demonstrated higher odds of all-complications compared to FRED use (OR: 1.49; 95% CI: 1.00-2.21; p=0.05) but showed comparable thromboembolic rates (OR: 0.77; 95% CI: 0.44-1.36; p=0.37).

Conclusion : This study compared two different flow diverters. 6-months occlusion rate was lower in FRED use, whereas at the end of follow-up duration, the total occlusion rate was significantly lower in PED. FRED use demonstrated superior favorable outcomes. Moreover, FRED was associated with lower rates of all-complications, however, thromboembolic rates were comparable. Additional head-to-head clinical trials with longer follow-up durations are needed to draw accurate conclusions.