Introduction Flow diversion for posterior circulation aneurysms using flow diversion constitutes an increasingly common off-label use. Basilar apex aneurysms are daunting lesions that present a significant treatment challenge. This is the largest series of basilar apex aneurysms treated with flow diversion to-date.
Methods A retrospective review of prospectively maintained databases at eight academic institutions was performed from the years 2009 to 2016 to identify patients with basilar apex aneurysms treated with PED placement. Clinical and radiographic data were analyzed with emphasis on occlusion and complication rates.
Results 16 consecutive patients (median age 62 years, male:female ratio of 1:2.2) underwent 18 procedures to treat 131 posterior circulation aneurysms with either Pipeline Embolization Device or Flow Redirection Endoluminal Device. All but one patient (94%) had a neurologic deficit attributable to the aneurysm prior to their procedure. Four attempts (25%) at flow-diversion were performed for aneurysmal subarachnoid hemorrhage, with 3 for saccular and 1 for blister morphology.At a median follow-up of 9 months, complete (100%) and near-complete (90%–99%) occlusion was noted in 69% of aneurysms. The rate of partial (<90%) occlusion was higher in patients treated with flow-diversion alone (3/7; 43%) and flow-diversion with coiling (2/9; 22%). However, there was no apparent difference in mRS at follow-up. Retreatment with an additional flow-diverter occurred in patients with larger aneurysm necks (8 and 15 mm) and adjunctive coiling, but had no other attributes in common. Major complications (≥2 points in mRS change) occurred in one patient (6%), who experienced PCA and cerebellar strokes as well as SAH after placement of a single flow diverter. Minor complications (<2 points in mRS change) occurred in 3 additional patients (19%). Symptomatic thromboembolic and hemorrhagic complications occurred in 2/18 of procedures, each (13%); all in the postprocedural setting. In addition, 1/18 procedure resulted in development of perianeurysmal edema and mass effect (6%). Aneurysms with intraluminal thrombus had higher complication rates, though they were not necessarily larger.
Conclusion Flow diversion for the treatment of basilar apex aneurysms results in acceptable occlusion rates, and compares favorably with the natural history of the disease. Both primary flow diversion and rescue after clipping/coiling resulted in mRS that was either equal or better than at presentation, and the technology represents a viable alternative to primary coiling or clipping in patients who are poor candidates for these.
Disclosures A. Dmytriw: None. N. Adeeb: None. A. Kumar: None. C. Griessenauer: None. C. Ogilvy: None. P. Foreman: None. H. Shallwani: None. N. Limbucci: None. S. Mangiafico: None. C. Michelozzi: None. T. Krings: None. V. Mendes Pereira: None. C. Matouk: None. Y. Zhang: None. M. Harrigan: None. K. Phan: None. H. Shakir: None. A. Siqqiqui: None. E. Levy: None. L. Renieri: None. C. Cognard: None. A. Thomas: 2; C; Research Steering Committee, Stryker. T. Marotta: None.
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