Flow diverter devices in the treatment of posterior communicating artery aneurysms: mid-term clinical and radiological outcomes

Abstract

Background: In the last decade, flow diverter (FD) devices are one of the widely used endovascular methods in the treatment of intracranial aneurysms. As the frequency of its use is increasing progressively, we thought that studies concerned with the use of FD at specific locations are helpful to clarify the efficacy and safety of FD as a treatment option in cerebral aneurysms. We represent our experiences in the treatment of posterior communicating artery (PCOM) aneurysms by FD devices aiming to assess its angiographic efficacy (complete aneurysm occlusion) and its related complications. This is a retrospective study of 47 patients harboring 47 PCOM aneurysms treated with Pipeline Embolization Device (PED). Acutely ruptured and non-saccular aneurysms were excluded from the study. Short-and mid-term radiological and clinical outcomes were analyzed. Results: Procedure-related complications were observed in five patients (two ischemic events, two transient ischemic attacks (TIA), and one ipsilateral distal hemorrhage) with no procedure-related mortality. Complete aneurysm occlusion was encountered in 87.2%. In multivariable analysis, large-sized aneurysm and incorporated vessels were an independent predictor of non-occlusion (P = 0.026 and P = 0.035 respectively). A favorable clinical outcome (modified Rankin Scale, 0-2) was observed in 45/47 patients (95.7%); the incidence of postoperative complications was an independent predictor of unfavorable clinical outcomes (P = 0.048). Conclusion: PED stent provides a high occlusion rate in the treatment of PCOM aneurysms with good posttreatment clinical outcomes.

Flow Diverter Performance in Aneurysms Arising From the Posterior Communicating Artery: A Systematic Review and Meta-Analysis

“…Twelve studies were retrospective, and of these, 7 were single center 4,5,8,15-18 and 5 multicenter. 2,6,10,19,20 Only one study had a prospective multicenter design. 3 The number of participants per study ranged from 5 to 57.…”

“…Previously published series have postulated concerns after the implantation of FDs in these cases because of the decreased efficacy and high recurrence rates caused by the high flow through the FPComA, which prevents endothelialization, and the potential risk for ischemic complications (large infarcts) if complete arterial occlusion occurs. 4,6-10…”

“…Previously published series have postulated concerns after the implantation of FDs in these cases because of the decreased efficacy and high recurrence rates caused by the high flow through the FPComA, which prevents endothelialization, and the potential risk for ischemic complications (large infarcts) if complete arterial occlusion occurs. 4,[6][7][8][9][10] In this study, we performed a systematic review and metaanalysis of the literature to evaluate the safety and effectiveness of FDs for the treatment of PComA aneurysms. Furthermore, we compared these outcomes in patients with FPComAs.…”

Factors Influencing Outcome of Treatment of Posterior Communicating Arteries Aneurysm

“…The term true posterior communicating artery aneurysm (PComA) is used to refer to an aneurysm arising from (PComA) and not to any other site (either the internal carotid or the posterior cerebral artery). 5 This study was conducted on 39 patients for two years who had a posterior communicating artery aneurysm that was treated surgically or endovascularly at Neurosurgery department, Al-Azhar hospitals, and Damanhur medical national institute.…”

“…In our study, as regards the operative complications, 74.4% showed no complications, 20.5% presented with Vasospasm, 2.6% presented with Stenosis, and 2.6% presented with Intraoperative bleeding. Moubark et al, 5 reported that data talked about the complications related to the procedure that occurred in five patients (two ischemic, two TIA, and one ipsilateral distal hemorrhage).…”