Flow Diversion for Fusiform/Dissecting vs. Saccular Vertebrobasilar Aneurysms: Results from the Posterior Circulation Flow Diversion Registry
Mahmoud Dibas1, Juan Vivanco-Suarez1, Aaron Rodriguez-Calienes2, Gustavo M Cortez3, Vitor Mendes Pereira4, Hidehisa Nishi4, Gabor Toth5, Thomas Patterson6, David Altschul7, Chaim Feigen7, Muhammed Amir Essibayi8, Milagros Galecio-Castillo1, Johanna Fifi9, Stavros Matsoukas10, Peter Kan11, Muhammad Ubaid Hafeez12, Ajit Puri13, Anna Luisa Kuhn13, Ajay Wakhloo14, Margarita Rabinovich14, Priyank Khandelwal15, Matias Costa16, Stephen Monteith16, Ricardo Hanel3, Santiago Ortega Gutierrez17
1Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States, 2University of Iowa Hospitals and Clinics, 3Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL, USA, 4Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada., 5Cleveland Clinic Foundation, 6Cleveland Clinic, 7Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, 8Albert Einstein College of Medicine, 9Mount Sinai Hospital, 10Department of Neurological Surgery, Mount Sinai Health System, New York, NY, United States, 11Department of Neurosurgery, The University of Texas Medical Branch, Galveston, Texas, USA, 12University of Texas Medical Branch, 13Department of Radiology, Division of Neurointerventional Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA., 14Neurointerventional Radiology and Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA, 15Department of Neurological Surgery, New Jersey Medical School, Rutgers, Newark, New Jersey, United States, 16Cerebrovascular Neurosurgery, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA, 17University of Iowa
Objective:
This study compared the effectiveness and safety of flow diverters (FD) for the treatment of fusiform/dissecting and saccular intracranial aneurysms (IAs) located in the vertebrobasilar vessels
Background:
The use of FD for vertebrobasilar IAs especially fusiform/dissecting ones has been described previously with inconsistent clinical and radiological results
Design/Methods:
This is an analysis of the posterior circulation FD registry, a multicentric observational registry that included data of patients with vertebrobasilar IAs. Patients and IAs characteristics and outcomes were compared between the fusiform/dissecting and saccular groups. Primary outcomes included complete occlusion (Raymond-Roy Class 1) at the latest follow-up and composite safety outcome (major stroke/procedure-related mortality for 1 year)
Results:
This study included 153 patients and IAs. Of those, 87 were fusiform/dissecting, while 66 were saccular. The fusiform/dissecting group were younger (median: 55 vs. 62 years, p=0.03) and occurred less in females (40.7% vs. 60.6%, p=0.023) as compared to the saccular group. The two groups were similar regarding presentation, Hunt and Hess, baseline modified Rankin Score (mRS), and previous-treatment. IAs location (mostly in vertebral artery: fusiform/dissecting, 58.6% vs. saccular, 42.4 %; p=0.95) was not different. The median size was higher in the fusiform/dissecting group as compared to the saccular group (9.9mm vs. 5.9mm, p<0.001). At an overall median follow-up time of 17.6 (IQR: 10.7-30.4 months), complete occlusion was observed in 62.6%, and was similar between the fusiform/dissecting and the saccular groups (61.4% vs. 64.2%, p=0.904). There was no difference in composite safety outcome (fusiform/dissecting, 9.2% vs. saccular, 10.8%, p=0.748) with an overall rate of 9.9%. The last follow up mRS 0-2 was similar between the two groups (p=0.582). Those who had mRS>2 tended to have worse outcomes and mRS at last follow up
Conclusions:
FD is effective and safe for fusiform/dissecting as well as saccular IAs. Careful selection for FD treatment based on mRS is critical