Introduction Flow diverters (FDs) with surface modification (SM) have emerged as a strategy to reduce stent thrombogenicity in patients undergoing embolization of intracranial aneurysms. However, its impact in clinical practice remains uncertain. We conducted a systematic review and meta‐analysis to evaluate the impact of SM on angiographic and periprocedural outcomes in patients with intracranial aneurysms undergoing flow diversion. Methods A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases from inception through July 2025. Studies comparing the outcomes between flow diverters with and without SM were included. Outcomes of interest included 12‐month occlusion rates by O’Kelly‐Marotta or Raymond‐Roy grading scales, as well as periprocedural thromboembolic and hemorrhagic complications. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random‐effects model, with heterogeneity assessed by I 2 statistics. Results Nine studies, comprising 2,332 patients (SM‐FDs: 783, non‐SM‐FDs: 1,549), were included. Risks of periprocedural thromboembolic or ischemic complications were lower in the SM‐FD group (RR: 0.44; CI: 0.22‐0.87; p = 0.019). However, no significant difference was observed for periprocedural hemorrhagic complications (RR: 0.74; CI: 0.26‐2.16; p = 0.587). There were no statistically significant differences observed at any follow‐up interval (immediately after treatment, at 6, and 12 months) in the unadjusted analyses of adequate and complete aneurysm occlusion. Interestingly, SM‐FDs were found to have significantly higher rates of adequate (RR: 1.31; CI: 1.08‐1.59; p = 0.006) and complete (RR: 1.20; CI: 1.05‐1.36; p = 0.006) occlusion at 6‐month follow‐up in sensitivity analyses. Conclusion Our findings support the real‐world efficacy of SM‐FDs in reducing thromboembolic complications in patients with intracranial aneurysms undergoing flow diversion. Further studies with a more granular design and a higher level of evidence are warranted to confirm these findings. image image
Lee et al. (Sat,) studied this question.