Abstract Introduction Flow-diverting (FD) stents are increasingly used to treat small, unruptured intracranial aneurysms (UIA), but high-quality, unbiased data on initial complications and clinical outcomes were limited in previous literature reviews. We updated the literature review to assess quality, potential bias, complications and short-term outcomes in studies on FD-stents for UIAs. Patients and methods We systematically searched PubMed, Embase and Cochrane Library until January 9, 2025 for studies on FD-stents for UIAs. We assessed methodological quality using the methodological index for non-randomised studies (poor: 0–9, moderate: 10–13, good: 14–16), and financial conflicts of interest. The primary outcome was neurological outcome according to a validated outcome scale at 1–3 months after treatment. Secondary outcomes were clinical worsening and complications. Results We included 13 studies with 743 patients and 806 UIAs, of which 88.4% (95% CI: 85.7%–91.2%) were 10 mm. All studies were uncontrolled. The methodological quality was poor in six and moderate in seven studies. Financial conflicts of interest were reported in six studies. At 1–3 months after treatment, the proportion of patients were for mRS ⩾1 13.3% (95% CI: 10.0%–16.6%), mRS ⩾2 5.3% (95% CI: 3.2%–7.5%), mRS ⩾3 2.4% (95% CI: 0.1%–3.9%) and neurological worsening 3.1% (95% CI: 1.5%–4.6%). Complications within 3 months occurred in 12.7% (95% CI: 10.3%–15.0%). Discussion and conclusion The literature on FD-stents is methodologically weak and potentially biased by financial interests but still shows relevant proportions of complications and post-treatment morbidity. Currently, there are no good data supporting the use of FD-stents for UIAs where standard treatment options are available. Randomised-controlled trials are needed to compare safety, efficacy and durability between FD-stents and coiling or clipping.
Wenz et al. (Thu,) studied this question.