A Systematic Literature Review and Meta-Analysis of the Treatment of Ruptured Intracranial Aneurysms with Hydrophilic Polymer and Phosphorylcholine-Coated Flow Diverters Under Single Antiplatelet Therapy

OBJECTIVE: Flow diverters coated with antithrombo-genic substances were recently introduced and have shown encouraging results in the preclinical setting. Our aim was to analyze their clinical application in patients with ruptured intracranial aneurysms using single anti-platelet therapy (SAPT).METHODS: We performed a PRISMA-compliant system-atic review and meta-analysis covering 3 major data bases u ntil March 2022.Two reviewers independently reviewed clinical studies for eligibility.Random-effects analysis of proportions was used to pool safety outcomes (hemor-rhagic, thrombembolic, and overall complications). Studies were tested for publication bias and heterogeneity.RESULTS: Five studies reporting 43 patients with 46 an-eurysms were identified. More than 1 stent was implanted in 16%, and additional coil embolization was performed in 53.8% of patients. SAPT with one of various acetylsalicylic acid regimens was used in 86%, altogether antiplatelet protocols were variable. The pooled risks of thromboem-bolic (23.9%; 95% confidence interval [CI], 9.6-47.9), hem-orrhagic (9.4%; 95% CI, 3.6-22.6), and overall complications (28.3%; 95% CI, 12.4-52.5) were calculated in the absence of publication bias with low to moderate study heteroge-neity measures. All complications occurred in patients u nder acetylsalicylic acid SAPT. Adequate aneurysm oc-clusion was described in 65.5% of patients.few retro-spective observational studies with moderate heterogeneity, encompassing a limited number of patients treated with variable SAPT regimens.CONCLUSIONS: Flow diversion for ruptured aneurysms u nder SAPT with coated stents is feasible. Although the risk of hemorrhagic complications was low, thromboem-bolic complications occurred in a significant number of patients, all under ASA SAPT.