Introduction: Flow diversion has been widely accepted for aneurysms in the anterior circulation but remains controversial for those in posterior circulation due to higher morbidity. We assessed the safety and efficacy of the Pipeline Embolization Device (PED) for the treatment of posterior circulation aneurysms.
Methods: Retrospective study. Patients with unruptured posterior circulation aneurysms treated with PED between 2011 and 2017 were included. Primary endpoints were procedure-related mortality rate and occurrence of neurological events during periprocedural period (within 30 days) and in delayed fashion (= 30 days). Secondary endpoints included rates of functional outcome, aneurysm occlusion, retreatment, and all-cause mortality. Sub-analyses, based on aneurysm morphology and number of PEDs, were performed.
Results: Thirty-two patients with 35 aneurysms (mean 8.3±5.5 mm) were included. No procedure-related mortality occurred. Rates of major neurological events during periprocedural period and in delayed fashion were 3.1% (1/32) and 12.5% (4/32), respectively. Favorable outcomes (mRS 0-2) at discharge and last follow-up were 87.5% (28/32) and 83.3% (25/30), respectively. Complete aneurysm occlusion was achieved in 69.7% (23/33) and 3 aneurysms underwent retreatment. All-cause mortality rate was 6.3% (2/32). Overall, there was no difference in neurological complications between saccular and non-saccular aneurysms. Although not statistically significant, higher rates of major neurological events occurred when using multiple PEDs within periprocedural period and in delayed fashion (11.1% vs 0%; 33.3% vs 4.3%).
Conclusions: PED is a feasible option in selected patients for the treatment of posterior circulation aneurysms regardless of morphology, however, higher rates of neurological complications occur when using multiple devices.
Patient Care: To date, there is no standard of treatment for posterior circulation aneurysms and flow diversion may be a feasible and valid alternative in select cases.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of flow diversion in the treatment of posterior circulation aneurysms.
2) Discuss the importance of endovascular strategies for the treatment of posterior circulation aneurysms.
3) Identify the use of flow diverters as a feasible and valid alternative in select patients.