Flow-diverter stents for endovascular management of non-fetal posterior communicating artery aneurysms-analysis on aneurysm occlusion, vessel patency, and patient outcome
Division of Neuroimaging and Intervention, Department of Radiology; New England Center for Stroke Research
Cardiovascular Diseases | Equipment and Supplies | Nervous System Diseases | Radiology | Surgery
Use of flow-diversion technology in the treatment of incidental and recanalized posterior communicating artery (PComA) aneurysms.
Patients treated with the Pipeline embolization device (PED) for PComA aneurysms were identified and included in our retrospective analysis. We evaluated aneurysm characteristics, modified Rankin Scale score (mRS) on admission, angiography follow-up, and patient clinical outcome at discharge, at three to nine months, and at 12-18 months.
We included 56 patients with a mean age of 56 years. Median mRS on admission was 0. All aneurysms involved the PComA and were either new findings or found to have shown recanalization at angiography follow-up from previous coil embolization or surgical clipping. Intraprocedural device foreshortening was observed in one case requiring additional placement of a self-expanding stent. One intraprocedural aneurysm rupture occurred because of a broken distal wire. This patient had an mRS of 4 after the procedure. Three- to nine-month and 12- to 18-month follow-up angiography showed near complete or complete aneurysm occlusion in most cases. Minimal to mild intimal hyperplasia was seen in five cases at three to nine months. PComA patency over time showed 29 of 46 initially patent vessels still patent at six months. Thirteen and seven PComAs showed progressive decrease in flow at three to nine months and 12-18 months, respectively. Median mRS remained 0 for all patients at three- to nine-month and 12- to 18-month follow-up.
Our preliminary results show that flow-diversion technology is an effective and safe treatment option. Larger studies with long-term follow-up are needed to validate our promising results.
Intracranial aneurysm, flow diverter, posterior communicating artery, stent
DOI of Published Version
Interv Neuroradiol. 2018 Jan 1:1591019918759735. doi: 10.1177/1591019918759735. [Epub ahead of print] Link to article on publisher's site
Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences
Kuhn AL, Dabus G, Kan P, Wakhloo AK, Puri AS. (2018). Flow-diverter stents for endovascular management of non-fetal posterior communicating artery aneurysms-analysis on aneurysm occlusion, vessel patency, and patient outcome. Radiology Publications and Presentations. https://doi.org/10.1177/1591019918759735. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/387