학술논문
Abstract 038: Fusiform/Dissecting vs. Saccular Posterior Circulation Aneurysms Treated with Flow Diversion: A Multicenter Study
Document Type
article
Author
Juan Vivanco Suarez; Mahmoud Dibas; Aaron Rodriguez‐Calienes; Gustavo Cortez; Ricardo Hanel; Hidehisa Nishi; Vitor Pereira; Chaim Feigen; David Altschul; Stavros Matsoukas; Johanna Fifi; Muhammad Hafeez; Peter Kan; Anna Kühn; Ajit Puri; Margarita Rabinovic; Ajay Wakhloo; Priyank Khandelwal; Milagros Galecio‐Castillo; Mudassi Farooqui; Santiago Ortega‐Gutierrez
Source
Stroke: Vascular and Interventional Neurology, Vol 3, Iss S2 (2023)
Subject
Language
English
ISSN
2694-5746
Abstract
Introduction Flow diverters have demonstrated reliable safety and effectiveness for the treatment of selected anterior circulation intracranial aneurysms. However, posterior circulation aneurysms comprise around 10‐15% of all aneurysms, and they frequently present atypical morphological and anatomical characteristics. Furthermore, these lesions have an increased risk of rupture (compared to those in the anterior circulation) with respect to size and higher treatment risks (regardless of the technique). Flow diversion in posterior circulation aneurysms has been described previously with inconsistent clinical and radiological results. Hence, we aimed to compare the safety and effectiveness of FDs in fusiform/dissecting vs. saccular aneurysms located in the vertebrobasilar vessels. Methods We performed a multicenter, retrospective cohort study including 9 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 (fusiform/dissecting vs. saccular). The effectiveness outcome was complete aneurysm occlusion (Raymond‐Roy Class 1) at the latest follow‐up. Safety outcomes included the incidence of ischemic/hemorrhagic and mortality. After adjusting for confounders multivariable logistic regressions were performed to compare outcomes of interest. Results A total of 147 patients with 147 aneurysms were included. The fusiform/dissecting group included 85 cases, while the saccular group 62. The saccular group had older patients (median age: fusiform/dissecting, 55 years [45‐64] vs. saccular, 63 years [51‐70.0]; p=.02). The number of female patients was not different between groups (fusiform/dissecting, 42% vs. saccular, 58%; p=.05). Clinical presentation, comorbidities, modified Fisher, and Hunt and Hess were similar. Baseline modified Rankin Score (mRS) was different (mRS 0‐2: fusiform/dissecting, 84% vs. saccular, 98%; p=.030). Previous endovascular treatment (p=.396) was similar. Aneurysm location (most were in the vertebral artery: fusiform/dissecting, 60% vs. saccular, 42%; p=.009) was different. Median aneurysm size (fusiform/dissecting, 10.0 mm [6.5‐18.8] vs. saccular, 5.9 [3.0‐10.0]; p=1 FD: fusiform/dissecting, 36% vs. saccular, 10%; p=