Flow Diversion for Distal Aneurysms of the Posterior Circulation: A Sub-analysis of the Post-FD Registry
Sophie Shogren1, Mahmoud Dibas1, Juan Vivanco-Suarez1, Aaron Rodriguez-Calienes1, Gustavo Cortez2, Vitor Mendes Pereira3, Hideheisa Nishi3, Gabor Toth4, Thomas Patterson4, David Altschul5, Chaim Feigen5, Muhammed Amir Essibayi5, Milagros Galecio-Castillo1, Johanna Fifi6, Stavros Matsoukas6, Peter Kan7, Muhammad Ubaid Hafeez7, Ajit Puri8, Anna Luisa Kuhn8, Ajay Wakhloo9, Margarita Rabinovich9, Priyank Khandelwal10, Matias Costa11, Stephen Monteith11, Ricardo Hanel2, Santiago Ortega Gutierrez1
1University of Iowa Hospitals and Clinics, 2Baptist Neurological Institute, 3St Michael's Hospital, Toronto, 4Cleveland Clinic, 5Montefiore Medical Center, 6Mount Sinai Health System, 7University of Texas Medical Branch, 8University of Massachusetts Chan Medical School, 9Lahey Hospital and Medical Center, 10New Jersey Medical School, Rutgers, 11Swedish Neuroscience Institute
Objective:
To investigate the outcomes of flow diversion for distal aneurysms of the posterior circulation.
Background:
Flow diversion (FD) has emerged as an effective treatment option for intracranial aneurysms (IAs). However, there is limited evidence regarding its safety and efficacy, specifically for distal aneurysms of the posterior circulation. This study aimed to investigate the outcomes of FD for aneurysms arising from the posterior inferior cerebellar artery (PICA), anterior inferior cerebellar artery (AICA), superior cerebellar artery (SCA), and the P2 and P3 segment of the posterior cerebral artery (PCA).
Design/Methods:
This sub-analysis of the posterior circulation FD (Post-FD) registry included data for patients harboring distal aneurysms of the posterior circulation in the PICA, AICA, SCA, and PCA P2-3 treated with FD. Aneurysm characteristics and outcomes were calculated for the total series, and a comparison was performed between fusiform/dissecting versus saccular aneurysms. Primary effectiveness was complete occlusion (Raymond Roy Class 1). Primary safety outcome was major stroke (ischemic/hemorrhagic). Secondary outcomes included retreatment and in-stent stenosis.
Results:
Overall, 36 patients with 36 aneurysms were treated with FD and had a median age, in years, of 60.0 (interquartile range [IQR]: 52.8-65.3 years). Of those, 13 were fusiform/dissecting while 23 were saccular IAs. Complete occlusion was achieved in 78.1% for all IAs at a median follow-up of 14.0 months (IQR: 9.3-48.6 months). There was a non-significant trend in rates of complete occlusion between fusiform/dissecting (91.7%) and saccular aneurysms (70%, p=0.151). Major stroke was reported in two cases (5.6%), in-stent stenosis in two (5.6%), and retreatment was required for four IAs (11.4%). There was no difference in rates of major stroke, in-stent stenosis, or retreatment between fusiform/dissecting and saccular IAs.
Conclusions:
This study suggests safety and efficacy of FD for distal aneurysms of the posterior circulation, particularly fusiform/dissecting aneurysms. Further larger-scale studies are warranted to confirm these findings.