Endovascular Strategies for Internal Carotid Artery Bifurcation Aneurysms: Clinical Outcomes

Introduction Internal carotid artery (ICA) bifurcation aneurysms are a rare subtype of intracranial aneurysms with distinct hemodynamic characteristics and treatment challenges. This study aims to evaluate clinical outcomes associated with different endovascular approaches for ICA bifurcation aneurysms through a systematic review and meta‐analysis. Method A comprehensive literature search through PubMed and Scopus from January 2000 to July 2025. Data on patient demographics, aneurysm characteristics, and outcomes of coil embolization, stent‐assisted coiling, and flow diversion were extracted. Pooled analyses and subgroup comparisons were performed following PRISMA guidelines. Results Among 322 patients from 17 studies, primary coiling was most common (59.0%), followed by stent‐assisted coiling (30.1%) and flow diversion (10.2%). Endovascular treatment generally had good outcomes, with 74.5% achieving mRS 0‐2 and 72.4% complete occlusion. Recurrence was 13.0%, stroke occurred in 5.9%, and mortality was 2.8%. Stent‐assisted coiling had the best functional outcomes (97.7%) and high occlusion (75.3%) with low recurrence (8.1%) and no rebleeding. Primary coiling, while slightly less effective, had the best safety profile with stroke at 4.3% and mortality 2.7%. Flow diversion, used in complex cases, had higher risks, with stroke in 13.1% and mortality in 18.1%. Compared to flow diversion, primary coiling significantly lowered stroke (OR = 0.193, p = 0.009) and death (OR = 0.234, p = 0.036). No significant differences were found between stent‐assisted coiling and other methods, though trends favored it for efficacy. Conclusion Endovascular strategies for ICA bifurcation aneurysms are generally effective, with stent‐assisted coiling demonstrating favorable clinical and radiographic outcomes. Primary coiling embolization appears to offer the best safety profile, while flow diversion may carry higher procedural risks. Treatment selection should consider individual anatomical and clinical factors.