INTRODUCTION Treatment of complex anterior circulation aneurysms with flow diverters (FDs) has become common practice in neurovascular centers. However, this treatment method for posterior circulation aneurysms (PCAs) still remains controversial. METHODS Through searches for reports on the treatment of PCAs with FDs, we conducted a systematic review of the literature on its clinical efficacy and safety using random-effect binomial meta-analysis. RESULTS We included 14 studies, which reported on a total of 225 PCAs in 220 patients. Procedure-related good outcome rate was 79% (95% confidence interval (CI), 72-84), with significantly lower odds among patients with ruptured aneurysms and basilar artery aneurysms. Procedure-related mortality rate was 15% (95% CI 10-21), with significantly higher rates among patients with giant aneurysms and basilar artery aneurysms. The rate of complete aneurysm occlusion at 6-month digital subtraction angiography (DSA) was 84%. Ischemic stroke rate was 11%. Perforator infarction rate was 7%. Postoperative subarachnoid hemorrhage (SAH) rate was 3%. Intraparenchymal hemorrhage (IPH) rate was 4%. CONCLUSIONS Flow diverter treatment of PCAs is an effective method, which provides a high rate of complete occlusion at 6-month DSA. However, compared with anterior circulation aneurysms, patients with PCAs are at significantly higher risk of mortality, ischemic stroke and perforator infarction. Our findings indicate that, in most clinical centers, flow diverter treatment of PCAs should be conducted in carefully selected patients with poor natural history and no optimal treatment strategy. For ruptured and giant basilar artery aneurysms, there is still no good treatment option.

中文翻译：

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分流器治疗后循环动脉瘤。荟萃分析。

引言用分流器（FDs）治疗复杂的前循环动脉瘤已成为神经血管中心的常见治疗方法。但是，这种后循环动脉瘤（PCA）的治疗方法仍存在争议。方法通过搜索有关FDs治疗PCA的报告，我们使用随机效应二项式荟萃分析对有关其临床疗效和安全性的文献进行了系统的综述。结果我们纳入了14项研究，这些研究报告了220例患者中总共225例PCA。手术相关的良好预后率为79％（95％置信区间（CI），72-84），动脉瘤破裂和基底动脉瘤患者的几率显着降低。与手术相关的死亡率为15％（95％CI 10-21），在巨大动脉瘤和基底动脉瘤患者中的发生率明显更高。在6个月的数字减影血管造影（DSA）情况下，完全动脉瘤的闭塞率为84％。缺血性中风发生率为11％。穿支梗死率为7％。术后蛛网膜下腔出血（SAH）率为3％。实质内出血（IPH）率为4％。结论PCA的分流治疗是一种有效的方法，可在6个月的DSA时提供较高的完全阻塞率。但是，与前循环动脉瘤相比，PCA患者的死亡，局部缺血性中风和穿孔性梗死的风险明显更高。我们的发现表明，在大多数临床中心，PCA的分流治疗应在精心挑选的自然病史较轻且没有最佳治疗策略的患者中进行。对于破裂的巨大基底动脉瘤，仍然没有好的治疗选择。