Abstract / Summary
Abstract Background Aneurysms of the posterior communicating artery (PCOM) segment constitute a substantial proportion of all cerebral aneurysms and pose unique therapeutic challenges owing to their anatomical relationship with the oculomotor nerve and the variability in PCOM calibre. While microsurgical clipping, endovascular coiling, and flow diversion each represent established interventional strategies, a pooled modality-specific synthesis examining all three approaches within this specific anatomical context has not been undertaken. Because the present analysis pools single-arm cohort data for each modality rather than directly comparing randomised treatment groups, all cross-modality contrasts should be regarded as exploratory and descriptive rather than causal. Objective The present analysis was designed to derive pooled estimates of complete aneurysm obliteration, treatment-associated adverse events, and delayed aneurysm recanalisation for each of the three modalities when applied to PCOM aneurysms. Methods Electronic databases including PubMed, Scopus, EMBASE, and the Cochrane Central Register were interrogated from inception to December 2024 in adherence with the PRISMA 2020 framework. Proportion meta-analysis was executed under a random-effects model employing the Freeman-Tukey double arcsine variance-stabilising transformation. Between-study inconsistency was quantified with the I 2 metric and Cochran Q statistic. Funnel plots served as the primary instrument for evaluating reporting asymmetry. Results A total of 39 eligible studies enrolling 7,460 patients met inclusion criteria. The pooled rate of complete obliteration was highest for clipping at 92.7% (95% CI 90.8–94.4%), followed by flow diversion at 73.1% (95% CI 69.6–76.3%), and coiling at 61.4% (95% CI 55.9–66.8%). Treatment-associated morbidity was 18.1% for clipping, 11.5% for coiling, and 6.3% for flow diversion. Recanalisation rates were markedly elevated after coiling (30.3%) relative to clipping (3.3%) and flow diversion (2.4%). Conclusion Surgical clip reconstruction yields the highest immediate obliteration rates at the expense of greater periprocedural morbidity. Coil embolisation affords a less invasive profile but is accompanied by the most pronounced recanalisation risk in the PCOM territory. Flow diversion occupies an intermediate position in obliteration efficacy with comparatively low adverse event and recurrence rates in the available literature; however, these findings should be interpreted cautiously given the predominance of elective, unruptured cases and shorter follow-up in the flow diverter cohort. Effectiveness is diminished in fetal-variant posterior communicating arteries. An individualised treatment algorithm incorporating patient- and anatomy-specific factors remains essential.