Background Endovascular treatment of cerebral aneurysms in the posterior circulation poses a challenge because of the higher rate of wide-necked aneurysms and presentation with rupture. In this study, we compare the baseline characteristics and outcomes of patients with posterior circulation aneurysms treated with novel second-generation coils in the SMART registry.

Methods SMART is a phase 4, multicenter, prospective, registry that enrolled patients with anterior and posterior circulation cerebral aneurysms (both ruptured and unruptured) who underwent endovascular treatment using Penumbra SMART™ Coils. Collected data included baseline clinical and angiographic characteristics at presentation. Primary and secondary end points were immediate angiographic occlusion, periprocedural complications, recanalization and retreatment rates and mortality at 1-year follow up. We compared the above variables between anterior and posterior circulation aneurysms.

Results Of a total of 906 patients treated in the SMART registry, 173 (19.1%) had posterior circulation aneurysms. In comparison to patients with anterior circulation aneurysms, patients with aneurysms in the posterior circulation were older (mean age 61.7 vs. 59.3 years, P 0.017) and more likely to present with rupture (38.7% vs. 30.3%, P 0.032). Posterior circulation aneurysms were more likely to be wide-necked (defined as an aneurysm with a dome-to-neck ratio less than 2.0 and/or a neck length of 4 mm or more). No significant difference was found in the rate of successful embolization at initial procedure (Raymond Class I), serious device-related adverse effects within 24 hours, one-year recanalization and one-year retreatment between both groups (table 1).

Conclusions Despite being associated with higher rates of rupture and wide-necked geometry, patients with posterior circulation aneurysms experienced immediate and one-year angiographic occlusion rates that were not significantly different from anterior circulation aneurysms. Device-related peri-procedural complications were also not significantly higher than the latter.

Disclosures E. Almallouhi: None. M. Sattur: None. M. Anadani: None. S. Al kasab: None. A. Spiotta: 2; C; Penumbra, Cerenovus, Minnetronix.