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  • Outcomes of Posterior Circulation Pipeline in 52 Cases at a Single Institution

    Final Number:
    1595

    Authors:
    Matthew T Bender MD; Geoffrey P Colby; Lin Li-Mei; Narlin B. Beaty MD; Bowen Jiang MD; Jessica K. Campos MD; Justin M. Caplan MD; Judy Huang MD; Rafael J Tamargo; Alexander L Coon

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Posterior circulation cerebral aneurysms are at higher risk of rupture and are more commonly symptomatic than anterior circulation aneurysms. Microsurgical clipping and to a lesser extent endovascular coiling carry significant morbidity. Early and limited reports of flow diversion for posterior circulation cerebral aneurysms have suggested high complication and low occlusion rates.

    Methods: A prospective, IRB-approved database was analyzed for all patients with posterior circulation aneurysms treated by flow diversion at our institution.

    Results: A total of 52 procedures (98% successful) were performed on 48 patients. The average aneurysm size was 9.4mm, including 14 large (29%) and 3 giant (6%) aneurysms. A majority of aneurysms were fusiform (33%) or dissecting (25%). 37% of patients were symptomatic, most commonly with stroke (19%) or prior/acute SAH (10%) and 63% were incidental. Vessel of origin was 67% vertebral, 21% basilar, and 12% PCA/SCA. The most common locations were: vertebrobasilar junction (19%), PICA (17%), mid-basilar (13%), and basilar apex (8%). The average number of devices was 1.6 (range 1-18) with adjunctive coiling in 17%. The major complication rate was 10%, all major strokes with mRS at last follow-up of (4, 1, 6, 3, and 4), and there was one mortality. There was no ICH or SAH. The minor complication rate was 8%, including minor stroke, TIA, and cranial nerve palsy. Male gender (p=0.016) and large or giant aneurysm size (p=0.022) were predictors of any complication on univariate analysis; morphology (0.235) notably was not and no predictor of complications was significant on multivariate logistic regression. Follow-up vascular imaging was performed on 79% of patients and showed complete aneurysm occlusion in 74% at last follow-up.

    Conclusions: This is the largest single-institution series of Pipeline for posterior circulation aneurysms and demonstrates acceptable safety and effectiveness in these challenging cases.

    Patient Care: This research supports the use of flow diversion in the treatment of posterior circulation cerebral aneurysms, offering a third treatment modality in addition to microsurgical clipping and endovascular coiling for these challenging aneurysms

    Learning Objectives: To report on the safety and efficacy of flow diversion for posterior circulation cerebral aneurysms

    References: n/a

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