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SNIS 20th annual meeting oral poster abstracts
P-017 Fusiform vs non-fusiform posterior circulation aneurysms treated with flow diversion: a multicenter study
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  1. J Vivanco-Suarez1,
  2. A Rodriguez-Calienes1,
  3. G Cortez2,
  4. H Nishi3,
  5. V Pereira3,
  6. M Costa4,
  7. C Feigen5,
  8. D Altschul5,
  9. S Matsoukas6,
  10. J Fifi6,
  11. M Hafeez7,
  12. P Kan7,
  13. A Kühn8,
  14. A Puri8,
  15. M Rabinovic9,
  16. A Wakhloo9,
  17. P Khandelwal10,
  18. Y Lu1,
  19. M Galecio-Castillo1,
  20. C Alva1,
  21. M Farooqui1,
  22. R Hanel2,
  23. S Ortega-Gutierrez1
  1. 1Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
  2. 2Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, FL, USA
  3. 3Divisions of Neurosurgery and Therapeutic Neuroradiology, St Michael’s Hospital, Toronto, ON, CANADA
  4. 4Cerebrovascular Neurosurgery, Swedish Neuroscience Institute, Seattle, WA, USA
  5. 5Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
  6. 6Department of Neurological Surgery, The Mount Sinai Hospital, New York, NY, USA
  7. 7Department of Neurosurgery, University of Texas Medical Branch Galveston, Galveston, TX, USA
  8. 8Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
  9. 9, Department of Interventional Neuroradiology, Lahey Hospital and Medical Center, Burlington, MA, USA
  10. 10Department of Neurological Surgery, New Jersey Medical School, Rutgers, Newark, NJ, USA

Abstract

Introduction/Purpose Flow diverters have demonstrated reliable safety and effectiveness for the treatment of selected intracranial aneurysms (IAs) located mainly in the anterior circulation. Posterior circulation aneurysms comprise around 10-15% of all aneurysms. They have an increased risk of rupture compared to equal-sized lesions in the anterior circulation, higher rates of thromboembolic complications during and after treatment, and more complex anatomical configurations. Importantly, the risk for complications may differ substantially based on the aneurysm type. Hence, we aimed to evaluate the safety and effectiveness of FDs in posterior circulation fusiform [FIA] vs. non-fusiform [non-FIA] aneurysms.

Materials and Methods We performed a multicenter, retrospective cohort study at 10 centers. All patients treated with FDs for aneurysms located in the posterior circulation (vertebral and basilar arteries) between 2015 and 2022 were included. Patients were divided into two groups according to the morphology of the aneurysm (FIA vs. non-FIA [saccular, blister, dissecting, mycotic]). The effectiveness outcome was measured by the rates of complete aneurysm occlusion using the Raymond-Roy classification at the latest follow-up. Safety outcomes included the incidence of ischemic/hemorrhagic and mortality.

Results A total of 97 patients with 97 aneurysms were included. The fusiform group included 28 cases, and the non-FIA 69 (44 saccular, 22 dissecting, 2 blister, 1 mycotic). Median age (FIA, 58 years [46.5-64.5] vs. non-FIA, 61 [47.0-70.0]; p=.579), and female sex (FIA, 56% vs. non-FIA, 63%; p=.565) were not different. Clinical presentation and comorbidities were similar. The rates of premorbid disability (mRS 3-5: FIA, 18% vs. non-FIA, 3%; p=.001) were different. Previous endovascular treatment (p=.793) and location (vertebral artery: FIA, 57% vs. non-FIA, 59%; p=.900) were similar. We found significant differences in median aneurysm size (FIA, 17.0 mm [10.4-27.0] vs. non-FIA, 6.5 [3.4-9.8]; p=.001), and proximal (FIA, 2.8 mm [2.3-3.3] vs. non-FIA, 3.2 [2.4-4.0]; p=.023) and distal landing (FIA, 3.1 mm [2.6-3.8] vs. non-FIA, 3.7 [2.8-4.1]; p=.046) zones were significantly different. The most commonly implanted FD was Pipeline Flex (FIA, 50%, vs. non-FIA, 43%). FIAs had a higher mean FDs per patient (FIA, 1.6±1.3 vs. non-FIA, 1.1±0.1; p=.002) and adjunctive coiling (FIA, 96% vs. non-FIA, 76%; p=.025). There were no differences in the rates of procedural and intrahospital ischemic/hemorrhagic events (p=.534). Follow-up ischemic/hemorrhagic events (FIA, 14.5% vs. non-FIA, 5%; p=.074) were similar. However, there was an increased trend in the rate of mortality events in the FIA group (15%) vs. non-FIA (7%) (p=.246). The rate of complete occlusion was higher in the non-FIA (69% vs. FIA, 54%), but this difference was not statistically significant (p=.116). The overall median follow-up time of 11.6 [1.2-24.8] months.

Conclusion We found that the treatment of posterior circulation FIAs with flow diversion had lowers rates of occlusion compared to non-FIA. The safety profile was lower than previously reported, suggesting the need for prospective studies to minimize non-adjudicated self-reporting bias on clinical outcomes.

Disclosures J. Vivanco-Suarez: None. A. Rodriguez-Calienes: None. G. Cortez: None. H. Nishi: None. V. Pereira: None. M. Costa: None. C. Feigen: None. D. Altschul: None. S. Matsoukas: None. J. Fifi: None. M. Hafeez: None. P. Kan: None. A. Kühn: None. A. Puri: None. M. Rabinovic: None. A. Wakhloo: None. P. Khandelwal: None. Y. Lu: None. M. Galecio-Castillo: None. C. Alva: None. M. Farooqui: None. R. Hanel: None. S. Ortega-Gutierrez: None.

https://doi.org/10.1136/jnis-2023-SNIS.89

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