To study the efficacy of a flow diverter (FD) versus stent-assisted coiling (SAC) for the treatment of small- and medium-sized intracranial wide-neck cystic aneurysms.

Data were collected over 6 months from patients with small- and medium-sized wide-neck intracranial cystic aneurysms treated with FD or SAC at the Shenzhen Second People's Hospital of Neurovascular Surgery, China, from October 2018 to February 2023. Occlusive outcomes and postoperative complications were compared after employing propensity score matching to control for confounding factors.

Our patient cohort comprised 118 patients with 141 aneurysms. FD was used to treat 112 aneurysms in 90 patients. SAC was used to treat 29 aneurysms in 28 patients. SAC-treated patients had a much higher short-term occlusion rate than FD-treated patients [86.2% (25/29) versus 58.9% (66/112), respectively; P = 0.006], as well as a lower postoperative complication rate [3.6% (1/29) versus 9.8% (11/112), respectively; P = 0.470]. In univariate analyses, the FD- and SAC-treated patients differed significantly in terms of sex, presence of multiple aneurysms, and angiographic occlusion. After employing a 1:1 propensity score matching analysis, 14 FD–SAC pairs were obtained through successful matching. A comparison showed that SAC-treated patients had a more complete occlusion rate than FD-treated patients (92.9% vs. 50%, respectively; P = 0.033).

Both FD and SAC were shown to have good safety and efficacy for treating small- and medium-sized intracranial wide-neck cystic aneurysms. However, stent-assisted embolization may be a better choice for high-risk or ruptured aneurysms.

Cystic aneurysm

Endovascular treatment

Flow diverter

Intracranial aneurysm

Stent-assisted embolization

Propensity score matching

Stent-assisted coiling

© 2025 The Author(s). Published by Elsevier Inc.