Posterior circulation flow diversion: A single-center experience and literature review

Gabor Toth, Mark Bain, M. Shazam Hussain, Shaye Moskowitz, Thomas Masaryk, Peter Rasmussen, Ferdinand Hui

Research output: Contribution to journalArticle

Abstract

Background Flow diverters have been used predominantly for large anterior circulation aneurysms. Data on the safety and efficacy of this treatment for posterior circulation aneurysms are limited. Objective To present our posterior circulation flow diverter experience, outcomes and morbidity in comparison with recent studies. Methods A retrospective chart and imaging review of six patients with seven aneurysms in posterior circulation vessels, treated with flow diverter technology was carried out. A literature review was performed using standard online search tools. Results We included five saccular and two fusiform posterior circulation aneurysms. An average of two flow diverters was placed for each patient. Adjunctive coiling was used in three cases. Follow-up at an average of 14.5 months showed complete angiographic occlusion in 4 (57.1%) cases, including one patient with in-stent thrombosis and major brainstem stroke at 4.5 months, a week after self-discontinuing dual antiplatelet therapy. Two other patients developed small periprocedural strokes but had excellent recovery. One death occurred 18 months after the initial procedure. No aneurysm rupture or parenchymal hemorrhage was seen. Overall, 5 (71%) cases, all with saccular aneurysms, had good clinical outcome (modified Rankin score (mRS) 0-1). Fusiform basilar aneurysms had markedly worse outcomes (mRS 5 and 6). Our literature review yielded six other studies with 100 additional patients. Overall, good outcome was seen in 74.3%, with a 12.3% average mortality and 11% permanent neurologic deficit rate. Complete occlusion varied from 43% to 100%. Conclusions Flow diversion may be a possible treatment in carefully selected patients with high-risk atypical posterior circulation aneurysms, with poor natural history and no optimal treatment strategy. Symptomatic and fusiform large aneurysms appear to carry the highest risk. Further studies are necessary to assess the role of flow diversion in the posterior circulation.

Original languageEnglish (US)
Pages (from-to)574-583
Number of pages10
JournalJournal of NeuroInterventional Surgery
Volume7
Issue number8
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

Fingerprint

Aneurysm
Brain Stem Infarctions
Neurologic Manifestations
Natural History
Stents
Rupture
Thrombosis
Therapeutics
Stroke
Hemorrhage
Technology
Morbidity
Safety
Mortality

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Posterior circulation flow diversion : A single-center experience and literature review. / Toth, Gabor; Bain, Mark; Hussain, M. Shazam; Moskowitz, Shaye; Masaryk, Thomas; Rasmussen, Peter; Hui, Ferdinand.

In: Journal of NeuroInterventional Surgery, Vol. 7, No. 8, 01.08.2015, p. 574-583.

Research output: Contribution to journalArticle

Toth, Gabor ; Bain, Mark ; Hussain, M. Shazam ; Moskowitz, Shaye ; Masaryk, Thomas ; Rasmussen, Peter ; Hui, Ferdinand. / Posterior circulation flow diversion : A single-center experience and literature review. In: Journal of NeuroInterventional Surgery. 2015 ; Vol. 7, No. 8. pp. 574-583.
@article{9fad2958dad049aba1d61b8f5ed68650,
title = "Posterior circulation flow diversion: A single-center experience and literature review",
abstract = "Background Flow diverters have been used predominantly for large anterior circulation aneurysms. Data on the safety and efficacy of this treatment for posterior circulation aneurysms are limited. Objective To present our posterior circulation flow diverter experience, outcomes and morbidity in comparison with recent studies. Methods A retrospective chart and imaging review of six patients with seven aneurysms in posterior circulation vessels, treated with flow diverter technology was carried out. A literature review was performed using standard online search tools. Results We included five saccular and two fusiform posterior circulation aneurysms. An average of two flow diverters was placed for each patient. Adjunctive coiling was used in three cases. Follow-up at an average of 14.5 months showed complete angiographic occlusion in 4 (57.1{\%}) cases, including one patient with in-stent thrombosis and major brainstem stroke at 4.5 months, a week after self-discontinuing dual antiplatelet therapy. Two other patients developed small periprocedural strokes but had excellent recovery. One death occurred 18 months after the initial procedure. No aneurysm rupture or parenchymal hemorrhage was seen. Overall, 5 (71{\%}) cases, all with saccular aneurysms, had good clinical outcome (modified Rankin score (mRS) 0-1). Fusiform basilar aneurysms had markedly worse outcomes (mRS 5 and 6). Our literature review yielded six other studies with 100 additional patients. Overall, good outcome was seen in 74.3{\%}, with a 12.3{\%} average mortality and 11{\%} permanent neurologic deficit rate. Complete occlusion varied from 43{\%} to 100{\%}. Conclusions Flow diversion may be a possible treatment in carefully selected patients with high-risk atypical posterior circulation aneurysms, with poor natural history and no optimal treatment strategy. Symptomatic and fusiform large aneurysms appear to carry the highest risk. Further studies are necessary to assess the role of flow diversion in the posterior circulation.",
author = "Gabor Toth and Mark Bain and Hussain, {M. Shazam} and Shaye Moskowitz and Thomas Masaryk and Peter Rasmussen and Ferdinand Hui",
year = "2015",
month = "8",
day = "1",
doi = "10.1136/neurintsurg-2014-011281",
language = "English (US)",
volume = "7",
pages = "574--583",
journal = "Journal of NeuroInterventional Surgery",
issn = "1759-8478",
publisher = "BMJ Publishing Group",
number = "8",

}

TY - JOUR

T1 - Posterior circulation flow diversion

T2 - A single-center experience and literature review

AU - Toth, Gabor

AU - Bain, Mark

AU - Hussain, M. Shazam

AU - Moskowitz, Shaye

AU - Masaryk, Thomas

AU - Rasmussen, Peter

AU - Hui, Ferdinand

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background Flow diverters have been used predominantly for large anterior circulation aneurysms. Data on the safety and efficacy of this treatment for posterior circulation aneurysms are limited. Objective To present our posterior circulation flow diverter experience, outcomes and morbidity in comparison with recent studies. Methods A retrospective chart and imaging review of six patients with seven aneurysms in posterior circulation vessels, treated with flow diverter technology was carried out. A literature review was performed using standard online search tools. Results We included five saccular and two fusiform posterior circulation aneurysms. An average of two flow diverters was placed for each patient. Adjunctive coiling was used in three cases. Follow-up at an average of 14.5 months showed complete angiographic occlusion in 4 (57.1%) cases, including one patient with in-stent thrombosis and major brainstem stroke at 4.5 months, a week after self-discontinuing dual antiplatelet therapy. Two other patients developed small periprocedural strokes but had excellent recovery. One death occurred 18 months after the initial procedure. No aneurysm rupture or parenchymal hemorrhage was seen. Overall, 5 (71%) cases, all with saccular aneurysms, had good clinical outcome (modified Rankin score (mRS) 0-1). Fusiform basilar aneurysms had markedly worse outcomes (mRS 5 and 6). Our literature review yielded six other studies with 100 additional patients. Overall, good outcome was seen in 74.3%, with a 12.3% average mortality and 11% permanent neurologic deficit rate. Complete occlusion varied from 43% to 100%. Conclusions Flow diversion may be a possible treatment in carefully selected patients with high-risk atypical posterior circulation aneurysms, with poor natural history and no optimal treatment strategy. Symptomatic and fusiform large aneurysms appear to carry the highest risk. Further studies are necessary to assess the role of flow diversion in the posterior circulation.

AB - Background Flow diverters have been used predominantly for large anterior circulation aneurysms. Data on the safety and efficacy of this treatment for posterior circulation aneurysms are limited. Objective To present our posterior circulation flow diverter experience, outcomes and morbidity in comparison with recent studies. Methods A retrospective chart and imaging review of six patients with seven aneurysms in posterior circulation vessels, treated with flow diverter technology was carried out. A literature review was performed using standard online search tools. Results We included five saccular and two fusiform posterior circulation aneurysms. An average of two flow diverters was placed for each patient. Adjunctive coiling was used in three cases. Follow-up at an average of 14.5 months showed complete angiographic occlusion in 4 (57.1%) cases, including one patient with in-stent thrombosis and major brainstem stroke at 4.5 months, a week after self-discontinuing dual antiplatelet therapy. Two other patients developed small periprocedural strokes but had excellent recovery. One death occurred 18 months after the initial procedure. No aneurysm rupture or parenchymal hemorrhage was seen. Overall, 5 (71%) cases, all with saccular aneurysms, had good clinical outcome (modified Rankin score (mRS) 0-1). Fusiform basilar aneurysms had markedly worse outcomes (mRS 5 and 6). Our literature review yielded six other studies with 100 additional patients. Overall, good outcome was seen in 74.3%, with a 12.3% average mortality and 11% permanent neurologic deficit rate. Complete occlusion varied from 43% to 100%. Conclusions Flow diversion may be a possible treatment in carefully selected patients with high-risk atypical posterior circulation aneurysms, with poor natural history and no optimal treatment strategy. Symptomatic and fusiform large aneurysms appear to carry the highest risk. Further studies are necessary to assess the role of flow diversion in the posterior circulation.

UR - http://www.scopus.com/inward/record.url?scp=84937711489&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937711489&partnerID=8YFLogxK

U2 - 10.1136/neurintsurg-2014-011281

DO - 10.1136/neurintsurg-2014-011281

M3 - Article

C2 - 24984708

AN - SCOPUS:84937711489

VL - 7

SP - 574

EP - 583

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

IS - 8

ER -