OBJECTIVE: The use of the Pipeline embolization device (PED) for posterior circulation aneurysms is controversial. The aim of this study was to explore the safety and efficacy of PED for these aneurysms in a meta-analysis. Meta-regression was used to identify predictors for incomplete aneurysm occlusion and procedure-related complications. METHODS: PubMed, Web of Science, and OVID data-bases were searched to identify all published references evaluating the treatment effect of PED for posterior circulation aneurysms. Only studies written in English that reported original data and included >10 cases were considered for inclusion. Patient demographics, aneurysm characteristics, angiographic outcomes, and clinical outcomes were extracted. A random-effects model was adopted to pool the obliteration rates and complication rates across selected studies. Finally, we conducted meta-regression analysis to identify predictors of angiographic outcomes. RESULTS: 12 studies including 358 patients with 365 aneurysms were included. The pooled complete aneurysm obliteration rate was 82% (95% confidence interval 73%-90%), and pooled procedure-related complication rate was 18% (95% confidence interval 14%-22%). Increasing age predicted incomplete obliteration of aneurysms after PED treatment in these patients (P = 0.01). CONCLUSIONS: PED is an alternative to treat intracranial aneurysms of the posterior circulation, achieving high complete occlusion rates, but it is less effective in elderly patients. The risk of procedure-related complications is not negligible. Further larger, long-term follow-up studies are needed before definitive conclusions can be drawn.