Effect of Fetal Posterior Circulation on Efficacy of Flow Diversion for Treatment of Posterior Communicating Artery Aneurysms: A Multi-Institutional Study.
BACKGROUND: Flow diversion (FD) has emerged as an effective treatment modality for aneurysms of the posterior communicating artery (PCOM). Whether or not a fetal posterior circulation (FPC) affects PCOM aneurysm occlusion rates after FD remains undetermined. METHODS: We performed a retrospective cohort study in which treatment outcomes for FD of PCOM aneurysms from multiple institutions were reviewed. The primary outcome of interest was complete aneurysm occlusion at last follow-up. The presence of a FPC, defined as a PCOM diameter larger than that of the P1 segment, was noted and its relationship to complete aneurysm occlusion was investigated using a Cox proportional hazards model. RESULTS: There were 49 patients with 49 PCOM aneurysms treated with FD who met inclusion criteria for analysis. A FPC was present in 16 patients (32.7%). Complete aneurysm occlusion was observed in 34 patients (69.4%). Complete occlusion was less common for patients with a FPC (43.7% vs. 81.8%; P = 0.007). For patients with and without a FPC, median time to occlusion was 51 and 6 months, respectively (P = 0.002). Using a multivariable Cox proportional hazards model, a FPC was associated with reduced odds of complete occlusion on last follow-up (risk ratio 0.35, 95% confidence interval 0.14-0.89; P = 0.029). CONCLUSIONS: Our results indicate reduced efficacy of FD for the treatment of PCOM aneurysms associated with a FPC. These findings may influence treatment selection for aneurysms at this location.
Rinaldo, L; Brinjikji, W; Cloft, H; Lanzino, G; Gonzalez, LF; Kan, P; Castilla, LR
Volume / Issue
Start / End Page
Pubmed Central ID
Electronic International Standard Serial Number (EISSN)
Digital Object Identifier (DOI)