Initial Experience with the Pipeline Vantage Flow Diverter for Intracranial Aneurysms: A Systematic Review and Meta-Analysis

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Background: The Pipeline Vantage Flow diverter (Vantage) is the latest generation of Pipeline flow diverters introducing Cobalt-chronium drawn-filled tubing and 48 to 68 wires. Purpose: We report the initial safety and efficacy of Vantage in treating intracranial aneurysms in the published literature. Data Sources: A systematic review and meta-analysis was conducted according to established protocols. Searches were conducted in PubMed, Scopus, Web-of-Science, and Embase databases up to December 2023. Original studies reporting treatment outcomes for intracranial aneurysms using Vantage in more than five patients were included. Study Selection: Pooled data from 5 studies (373 patients, 418 aneurysms) were analyzed. Data Analysis: Outcomes of interest were: technical success, occlusion rates, complication outcomes and mortality. Data Synthesis: A technical success rate of 99.2% (95% CI: 98.29%–100%) was found. In unruptured cases, success rate was 378/383 (99.6%) versus 17/20 (85.0%) in ruptured cases (P < .01). Complete occlusion rate was 74.3% (95% CI: 67.43%–80.59%), with no significant difference between ruptured and unruptured cases (P = 0.72); median of follow up 6 months. Overall mortality rate was 1.2% (95% CI: 0.01%–3.64%), significantly higher in ruptured (18.6%; 95% CI: 5.13%–36.26%) versus unruptured cases (0.23%; 95% CI: 0%–1.36%) (P < 0.01). Hemorrhagic complications occurred at 1% (95% CI: 0%–3.36%) pooled rate. Thromboembolic complications were reported at 6.1% (95% CI: 2.60%–10.73%), decreasing to 4.35% (95% CI: 1.91%–7.54%) after excluding one outlier study. Limitations: Only five studies, some with small number of patients, were included in this meta-analysis which may limit the generalizability of our findings. The absence of long term follow-up also limits the assessment of treatment durability. Conclusions: In this meta-analysis, we found that Vantage initial experience is similar to previous version of the Pipeline Embolization Device in terms of safety and efficacy for treatment of intracranial aneurysms, in particular unruptured aneurysms. Further prospective and comparative studies with patient outcome data specific to aneurysm location are needed to confirm the safety and efficacy of Vantage.

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