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Case series
Flow diverters for ruptured posterior circulation perforator aneurysms: multicenter experience and literature review
  1. Valerio Da Ros1,
  2. Francesco Diana2,
  3. Federico Sabuzi1,
  4. Emanuele Malatesta2,
  5. Antioco Sanna2,
  6. Jacopo Scaggiante1,
  7. Francesca Di Giuliano1,
  8. Roberto Gandini3,
  9. Roberto Floris1,3,
  10. Maria Ruggiero2
  1. 1 Department of Biomedicine, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
  2. 2 Neuroradiology, Maurizio Bufalini Hospital, Cesena, Emilia-Romagna, Italy
  3. 3 Diagnostic Imaging and Interventional Radiology, University Hospital of Rome Tor Vergata, Rome, Italy
  1. Correspondence to Dr Valerio Da Ros, Fondazione PTV Policlinico Tor Vergata, 00133 Roma, Italy; darosvalerio{at}


Background The management of ruptured posterior circulation perforator aneurysms (rPCPAs) remains unclear. We present our experience in treating rPCPAs with flow diverter stents (FDs) and evaluate their safety and efficacy at mid- to long-term follow-up. A diagnostic and therapeutic algorithm for rPCPAs is also proposed.

Methods We retrospectively analyzed data from all consecutive patients with rPCPAs treated with FDs at our institutions between January 2013 and July 2019. Clinical presentations, time of treatments, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a mid- to long-term follow-up. A systematic review of the literature on rPCPAs treated with FDs was also performed.

Results Seven patients with seven rPCPAs were treated with FDs. All patients presented with an atypical subarachnoid hemorrhage distribution and a low to medium Hunt–Hess grade. In 29% of cases rPCPAs were identified on the initial angiogram. In 57% of cases, FDs were inserted within 2 days of the diagnosis. Immediate aneurysm occlusion was observed in 14% of the cases and in 71% at the first follow-up (mean 2.4 months). At mean follow-up of 33 months (range 3–72 months) one case of delayed ischemic complication occurred. Six patients had a modified Rankin Scale (mRS) score of 0 and one patient had an mRS score of 4 at the latest follow-up.

Conclusions The best management for rPCPAs remains unclear, but FDs seem to have lower complication rates than other treatment options. Further studies with larger series are needed to confirm the role of FDs in rPCPA.

  • aneurysm
  • brain
  • flow diverter
  • intervention
  • subarachnoid

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  • Contributors Conception and design of the work: VDR and FD. Data acquisition: FS, EM, AS, FDG. Data analysis and interpretation: VDR, FS, and MR. Drafting the work: VDR, FD, and FDG. Critical revision: FD, RF, RG, and MR. Final approval: all authors. All authors have read and approved the submitted manuscript. The manuscript has not been submitted elsewhere nor published elsewhere in whole or in part.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.