Flow Diversion of Posterior Circulation Cerebral Aneurysms: A Single-Institution Series of 59 Cases

Matthew T. Bender, Geoffrey P. Colby, Bowen Jiang, Li Mei Lin, Jessica K. Campos, Risheng Xu, Erick M. Westbroek, Chau D. Vo, David A. Zarrin, Justin Caplan, Judy Huang, Rafael J Tamargo, Alexander Coon

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Posterior circulation cerebral aneurysms are at higher risk of rupture and are more symptomatic than those in the anterior circulation. Existing treatments carry significant morbidity. Early reports of flow diversion for posterior circulation aneurysms have suggested high complication and low occlusion rates. OBJECTIVE: To report safety and efficacy of flow diversion with the pipeline embolization device (ev3, Medtronic Inc, Dublin, Ireland) for aneurysms located throughout the posterior circulation. METHODS: A prospective, institutional review board-approved database was analyzed for all patients with posterior circulation aneurysms treated by flow diversion at our institution. RESULTS: Fifty-nine embolization procedures were performed on 55 patients. Average aneurysm size was 9.4 mm. Morphology was saccular (45%), fusiform (29%), or dissecting/pseudo-aneurysms (25%). Sixty-two percent of aneurysms arose along the vertebral artery. There were 7 mid-basilar (13%) and 7 basilar apex (13%) aneurysms. Procedural success was 98%; 1 Pipeline embolization device was placed in 85%; and coiling was performed in 17% of cases. There were 5 major complications (8%), all strokes. Patients with major stroke had modified Rankin Scale score at last follow-up of 1, 3, 4, 6, and 6 (2 mortalities). There were zero intracerebral or subarachnoid hemorrhages. No variable predicted complications on univariate or multivariate analysis. Follow-up digital subtraction angiography was performed for 43 patients (78%). Complete occlusion was 68% at 6 mo and 78% at 12 mo. Average follow-up was 11.8 mo. Fusiform or dissecting morphology and large or giant aneurysm size were predictors of aneurysm persistence at 6 mo on multivariate logistic regression. CONCLUSION: This is a large single-institution series of Pipeline (Medtronic Inc) for posterior circulation aneurysms and demonstrates acceptable safety and effectiveness in these challenging cases.

Original languageEnglish (US)
Pages (from-to)206-216
Number of pages11
JournalNeurosurgery
Volume84
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Intracranial Aneurysm
Aneurysm
Stroke
Safety
Dissecting Aneurysm
Equipment and Supplies
Digital Subtraction Angiography
Vertebral Artery
Research Ethics Committees
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Ireland
Rupture
Multivariate Analysis
Logistic Models
Databases
Morbidity
Mortality

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Bender, M. T., Colby, G. P., Jiang, B., Lin, L. M., Campos, J. K., Xu, R., ... Coon, A. (2019). Flow Diversion of Posterior Circulation Cerebral Aneurysms: A Single-Institution Series of 59 Cases. Neurosurgery, 84(1), 206-216. https://doi.org/10.1093/neuros/nyy076

Flow Diversion of Posterior Circulation Cerebral Aneurysms : A Single-Institution Series of 59 Cases. / Bender, Matthew T.; Colby, Geoffrey P.; Jiang, Bowen; Lin, Li Mei; Campos, Jessica K.; Xu, Risheng; Westbroek, Erick M.; Vo, Chau D.; Zarrin, David A.; Caplan, Justin; Huang, Judy; Tamargo, Rafael J; Coon, Alexander.

In: Neurosurgery, Vol. 84, No. 1, 01.01.2019, p. 206-216.

Research output: Contribution to journalArticle

Bender, MT, Colby, GP, Jiang, B, Lin, LM, Campos, JK, Xu, R, Westbroek, EM, Vo, CD, Zarrin, DA, Caplan, J, Huang, J, Tamargo, RJ & Coon, A 2019, 'Flow Diversion of Posterior Circulation Cerebral Aneurysms: A Single-Institution Series of 59 Cases', Neurosurgery, vol. 84, no. 1, pp. 206-216. https://doi.org/10.1093/neuros/nyy076
Bender, Matthew T. ; Colby, Geoffrey P. ; Jiang, Bowen ; Lin, Li Mei ; Campos, Jessica K. ; Xu, Risheng ; Westbroek, Erick M. ; Vo, Chau D. ; Zarrin, David A. ; Caplan, Justin ; Huang, Judy ; Tamargo, Rafael J ; Coon, Alexander. / Flow Diversion of Posterior Circulation Cerebral Aneurysms : A Single-Institution Series of 59 Cases. In: Neurosurgery. 2019 ; Vol. 84, No. 1. pp. 206-216.
@article{9d63c006ed154a5594af9d4642d3d863,
title = "Flow Diversion of Posterior Circulation Cerebral Aneurysms: A Single-Institution Series of 59 Cases",
abstract = "BACKGROUND: Posterior circulation cerebral aneurysms are at higher risk of rupture and are more symptomatic than those in the anterior circulation. Existing treatments carry significant morbidity. Early reports of flow diversion for posterior circulation aneurysms have suggested high complication and low occlusion rates. OBJECTIVE: To report safety and efficacy of flow diversion with the pipeline embolization device (ev3, Medtronic Inc, Dublin, Ireland) for aneurysms located throughout the posterior circulation. METHODS: A prospective, institutional review board-approved database was analyzed for all patients with posterior circulation aneurysms treated by flow diversion at our institution. RESULTS: Fifty-nine embolization procedures were performed on 55 patients. Average aneurysm size was 9.4 mm. Morphology was saccular (45{\%}), fusiform (29{\%}), or dissecting/pseudo-aneurysms (25{\%}). Sixty-two percent of aneurysms arose along the vertebral artery. There were 7 mid-basilar (13{\%}) and 7 basilar apex (13{\%}) aneurysms. Procedural success was 98{\%}; 1 Pipeline embolization device was placed in 85{\%}; and coiling was performed in 17{\%} of cases. There were 5 major complications (8{\%}), all strokes. Patients with major stroke had modified Rankin Scale score at last follow-up of 1, 3, 4, 6, and 6 (2 mortalities). There were zero intracerebral or subarachnoid hemorrhages. No variable predicted complications on univariate or multivariate analysis. Follow-up digital subtraction angiography was performed for 43 patients (78{\%}). Complete occlusion was 68{\%} at 6 mo and 78{\%} at 12 mo. Average follow-up was 11.8 mo. Fusiform or dissecting morphology and large or giant aneurysm size were predictors of aneurysm persistence at 6 mo on multivariate logistic regression. CONCLUSION: This is a large single-institution series of Pipeline (Medtronic Inc) for posterior circulation aneurysms and demonstrates acceptable safety and effectiveness in these challenging cases.",
author = "Bender, {Matthew T.} and Colby, {Geoffrey P.} and Bowen Jiang and Lin, {Li Mei} and Campos, {Jessica K.} and Risheng Xu and Westbroek, {Erick M.} and Vo, {Chau D.} and Zarrin, {David A.} and Justin Caplan and Judy Huang and Tamargo, {Rafael J} and Alexander Coon",
year = "2019",
month = "1",
day = "1",
doi = "10.1093/neuros/nyy076",
language = "English (US)",
volume = "84",
pages = "206--216",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Flow Diversion of Posterior Circulation Cerebral Aneurysms

T2 - A Single-Institution Series of 59 Cases

AU - Bender, Matthew T.

AU - Colby, Geoffrey P.

AU - Jiang, Bowen

AU - Lin, Li Mei

AU - Campos, Jessica K.

AU - Xu, Risheng

AU - Westbroek, Erick M.

AU - Vo, Chau D.

AU - Zarrin, David A.

AU - Caplan, Justin

AU - Huang, Judy

AU - Tamargo, Rafael J

AU - Coon, Alexander

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND: Posterior circulation cerebral aneurysms are at higher risk of rupture and are more symptomatic than those in the anterior circulation. Existing treatments carry significant morbidity. Early reports of flow diversion for posterior circulation aneurysms have suggested high complication and low occlusion rates. OBJECTIVE: To report safety and efficacy of flow diversion with the pipeline embolization device (ev3, Medtronic Inc, Dublin, Ireland) for aneurysms located throughout the posterior circulation. METHODS: A prospective, institutional review board-approved database was analyzed for all patients with posterior circulation aneurysms treated by flow diversion at our institution. RESULTS: Fifty-nine embolization procedures were performed on 55 patients. Average aneurysm size was 9.4 mm. Morphology was saccular (45%), fusiform (29%), or dissecting/pseudo-aneurysms (25%). Sixty-two percent of aneurysms arose along the vertebral artery. There were 7 mid-basilar (13%) and 7 basilar apex (13%) aneurysms. Procedural success was 98%; 1 Pipeline embolization device was placed in 85%; and coiling was performed in 17% of cases. There were 5 major complications (8%), all strokes. Patients with major stroke had modified Rankin Scale score at last follow-up of 1, 3, 4, 6, and 6 (2 mortalities). There were zero intracerebral or subarachnoid hemorrhages. No variable predicted complications on univariate or multivariate analysis. Follow-up digital subtraction angiography was performed for 43 patients (78%). Complete occlusion was 68% at 6 mo and 78% at 12 mo. Average follow-up was 11.8 mo. Fusiform or dissecting morphology and large or giant aneurysm size were predictors of aneurysm persistence at 6 mo on multivariate logistic regression. CONCLUSION: This is a large single-institution series of Pipeline (Medtronic Inc) for posterior circulation aneurysms and demonstrates acceptable safety and effectiveness in these challenging cases.

AB - BACKGROUND: Posterior circulation cerebral aneurysms are at higher risk of rupture and are more symptomatic than those in the anterior circulation. Existing treatments carry significant morbidity. Early reports of flow diversion for posterior circulation aneurysms have suggested high complication and low occlusion rates. OBJECTIVE: To report safety and efficacy of flow diversion with the pipeline embolization device (ev3, Medtronic Inc, Dublin, Ireland) for aneurysms located throughout the posterior circulation. METHODS: A prospective, institutional review board-approved database was analyzed for all patients with posterior circulation aneurysms treated by flow diversion at our institution. RESULTS: Fifty-nine embolization procedures were performed on 55 patients. Average aneurysm size was 9.4 mm. Morphology was saccular (45%), fusiform (29%), or dissecting/pseudo-aneurysms (25%). Sixty-two percent of aneurysms arose along the vertebral artery. There were 7 mid-basilar (13%) and 7 basilar apex (13%) aneurysms. Procedural success was 98%; 1 Pipeline embolization device was placed in 85%; and coiling was performed in 17% of cases. There were 5 major complications (8%), all strokes. Patients with major stroke had modified Rankin Scale score at last follow-up of 1, 3, 4, 6, and 6 (2 mortalities). There were zero intracerebral or subarachnoid hemorrhages. No variable predicted complications on univariate or multivariate analysis. Follow-up digital subtraction angiography was performed for 43 patients (78%). Complete occlusion was 68% at 6 mo and 78% at 12 mo. Average follow-up was 11.8 mo. Fusiform or dissecting morphology and large or giant aneurysm size were predictors of aneurysm persistence at 6 mo on multivariate logistic regression. CONCLUSION: This is a large single-institution series of Pipeline (Medtronic Inc) for posterior circulation aneurysms and demonstrates acceptable safety and effectiveness in these challenging cases.

UR - http://www.scopus.com/inward/record.url?scp=85054606321&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054606321&partnerID=8YFLogxK

U2 - 10.1093/neuros/nyy076

DO - 10.1093/neuros/nyy076

M3 - Article

C2 - 29608702

AN - SCOPUS:85054606321

VL - 84

SP - 206

EP - 216

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 1

ER -