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Introduction Flow diverters have proved effective in the treatment of intracranial aneurysms with difficult anatomy. The deployment of flow diverters in supra clinoid ICA, ICA bifurcation or MCA aneurysms might require coverage of the pre communicating segment of ACA. However, there are few studies which have studied the safety and outcomes of ACA coverage. We thus intend to present a systematic review of the studies which have examined the outcomes of ACA coverage in flow diverter.Material and Methods We conducted a comprehensive search of PubMed, MEDLINE, and Embase databases following PRISMA guidelines (Preferred Reporting Items for Systematic reviews and Meta-analyzes) to identify studies which have reported flow diverter deployment with ACA coverage. Demographics, imaging including preoperative and follow up DSA of ACA circulation, comorbidities, clinical and radiological outcomes were analyzed. Ipsilateral ACA occlusion in the follow up imaging was considered as primary outcome.Results Eight studies with 184 patients were analysed, showing low heterogeneity (I 2 = 0%; Q = 2.01, p = 0.96). Patients averaged 53 years old, 62.5% female; 49% had hypertension and 25% smoked. Most aneurysms were in the supraclinoid ICA (59.3%), with others at the ICA bifurcation (27%) and MCA (19%). Mean aneurysm size was 7.7 mm, 13% presented as subarachnoid hemorrhage. Pipeline devices were used in 54.3%, Turbridge in 7.6%, and p64 in 7.06%; 93.4% used a single flow diverter. Ipsilateral ACA dominance occurred in 28.6%. Median follow-up was 10.2 months (IQR 1.8, range 6-22.3). After intervention, ipsilateral ACA remained patent in 64% (95%CI (0.56-0.72) and ACA infarct occurred in 2%95%CI (0.0077-0.042) ). Patency was significantly associated with age(OR:0.89 ,95% CI:0.80-0.95,p=0.02),use of pipeline flow diverter(OR:0.079,95%CI:0.033-0.0186,P<0.01), size of aneurysm(OR:1.18,95%CI:1.02-1.36),p=0.021)) and ipsilateral ACA diameter (p<0.01). Contralateral ACA hypoplasia and ipsilateral dominance were not significantly linked to patency. No major complications or deaths were reported.Conclusion Flow diverter deployment requiring ACA coverage is a safer option with low incidence of ischemic stroke. The ipsilateral ACA patency after deployment of flow diverter can be determined by ipsilateral ACA diameter, size of the aneurysm, rather than preoperative dominance of ACA or patency of ACOM.Disclosures K. Arumalla: None. B. Tong: None. A. Sonig: None.