Effect of Fetal Posterior Circulation on Efficacy of Flow Diversion for Treatment of Posterior Communicating Artery Aneurysms: A Multi-Institutional Study

Lorenzo Rinaldo, Waleed Brinjikji, Harry Cloft, Giuseppe Lanzino, L. Fernando Gonzalez, Peter Kan, Leonardo Rangel Castilla

Research output: Contribution to journalArticle

Abstract

Background: Flow diversion (FD) has emerged as an effective treatment modality for aneurysms of the posterior communicating artery (PCOM). Whether or not a fetal posterior circulation (FPC) affects PCOM aneurysm occlusion rates after FD remains undetermined. Methods: We performed a retrospective cohort study in which treatment outcomes for FD of PCOM aneurysms from multiple institutions were reviewed. The primary outcome of interest was complete aneurysm occlusion at last follow-up. The presence of a FPC, defined as a PCOM diameter larger than that of the P1 segment, was noted and its relationship to complete aneurysm occlusion was investigated using a Cox proportional hazards model. Results: There were 49 patients with 49 PCOM aneurysms treated with FD who met inclusion criteria for analysis. A FPC was present in 16 patients (32.7%). Complete aneurysm occlusion was observed in 34 patients (69.4%). Complete occlusion was less common for patients with a FPC (43.7% vs. 81.8%; P = 0.007). For patients with and without a FPC, median time to occlusion was 51 and 6 months, respectively (P = 0.002). Using a multivariable Cox proportional hazards model, a FPC was associated with reduced odds of complete occlusion on last follow-up (risk ratio 0.35, 95% confidence interval 0.14–0.89; P = 0.029). Conclusions: Our results indicate reduced efficacy of FD for the treatment of PCOM aneurysms associated with a FPC. These findings may influence treatment selection for aneurysms at this location.

Original languageEnglish (US)
Pages (from-to)e1232-e1236
JournalWorld neurosurgery
Volume127
DOIs
StatePublished - Jul 1 2019

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Intracranial Aneurysm
Aneurysm
Proportional Hazards Models
Therapeutics
Cohort Studies
Retrospective Studies
Arteries
Odds Ratio
Confidence Intervals

Keywords

  • Circle of Willis
  • Flow diverter
  • Intracranial aneurysm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Effect of Fetal Posterior Circulation on Efficacy of Flow Diversion for Treatment of Posterior Communicating Artery Aneurysms : A Multi-Institutional Study. / Rinaldo, Lorenzo; Brinjikji, Waleed; Cloft, Harry; Lanzino, Giuseppe; Gonzalez, L. Fernando; Kan, Peter; Castilla, Leonardo Rangel.

In: World neurosurgery, Vol. 127, 01.07.2019, p. e1232-e1236.

Research output: Contribution to journalArticle

Rinaldo, Lorenzo ; Brinjikji, Waleed ; Cloft, Harry ; Lanzino, Giuseppe ; Gonzalez, L. Fernando ; Kan, Peter ; Castilla, Leonardo Rangel. / Effect of Fetal Posterior Circulation on Efficacy of Flow Diversion for Treatment of Posterior Communicating Artery Aneurysms : A Multi-Institutional Study. In: World neurosurgery. 2019 ; Vol. 127. pp. e1232-e1236.
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abstract = "Background: Flow diversion (FD) has emerged as an effective treatment modality for aneurysms of the posterior communicating artery (PCOM). Whether or not a fetal posterior circulation (FPC) affects PCOM aneurysm occlusion rates after FD remains undetermined. Methods: We performed a retrospective cohort study in which treatment outcomes for FD of PCOM aneurysms from multiple institutions were reviewed. The primary outcome of interest was complete aneurysm occlusion at last follow-up. The presence of a FPC, defined as a PCOM diameter larger than that of the P1 segment, was noted and its relationship to complete aneurysm occlusion was investigated using a Cox proportional hazards model. Results: There were 49 patients with 49 PCOM aneurysms treated with FD who met inclusion criteria for analysis. A FPC was present in 16 patients (32.7{\%}). Complete aneurysm occlusion was observed in 34 patients (69.4{\%}). Complete occlusion was less common for patients with a FPC (43.7{\%} vs. 81.8{\%}; P = 0.007). For patients with and without a FPC, median time to occlusion was 51 and 6 months, respectively (P = 0.002). Using a multivariable Cox proportional hazards model, a FPC was associated with reduced odds of complete occlusion on last follow-up (risk ratio 0.35, 95{\%} confidence interval 0.14–0.89; P = 0.029). Conclusions: Our results indicate reduced efficacy of FD for the treatment of PCOM aneurysms associated with a FPC. These findings may influence treatment selection for aneurysms at this location.",
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AU - Kan, Peter

AU - Castilla, Leonardo Rangel

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N2 - Background: Flow diversion (FD) has emerged as an effective treatment modality for aneurysms of the posterior communicating artery (PCOM). Whether or not a fetal posterior circulation (FPC) affects PCOM aneurysm occlusion rates after FD remains undetermined. Methods: We performed a retrospective cohort study in which treatment outcomes for FD of PCOM aneurysms from multiple institutions were reviewed. The primary outcome of interest was complete aneurysm occlusion at last follow-up. The presence of a FPC, defined as a PCOM diameter larger than that of the P1 segment, was noted and its relationship to complete aneurysm occlusion was investigated using a Cox proportional hazards model. Results: There were 49 patients with 49 PCOM aneurysms treated with FD who met inclusion criteria for analysis. A FPC was present in 16 patients (32.7%). Complete aneurysm occlusion was observed in 34 patients (69.4%). Complete occlusion was less common for patients with a FPC (43.7% vs. 81.8%; P = 0.007). For patients with and without a FPC, median time to occlusion was 51 and 6 months, respectively (P = 0.002). Using a multivariable Cox proportional hazards model, a FPC was associated with reduced odds of complete occlusion on last follow-up (risk ratio 0.35, 95% confidence interval 0.14–0.89; P = 0.029). Conclusions: Our results indicate reduced efficacy of FD for the treatment of PCOM aneurysms associated with a FPC. These findings may influence treatment selection for aneurysms at this location.

AB - Background: Flow diversion (FD) has emerged as an effective treatment modality for aneurysms of the posterior communicating artery (PCOM). Whether or not a fetal posterior circulation (FPC) affects PCOM aneurysm occlusion rates after FD remains undetermined. Methods: We performed a retrospective cohort study in which treatment outcomes for FD of PCOM aneurysms from multiple institutions were reviewed. The primary outcome of interest was complete aneurysm occlusion at last follow-up. The presence of a FPC, defined as a PCOM diameter larger than that of the P1 segment, was noted and its relationship to complete aneurysm occlusion was investigated using a Cox proportional hazards model. Results: There were 49 patients with 49 PCOM aneurysms treated with FD who met inclusion criteria for analysis. A FPC was present in 16 patients (32.7%). Complete aneurysm occlusion was observed in 34 patients (69.4%). Complete occlusion was less common for patients with a FPC (43.7% vs. 81.8%; P = 0.007). For patients with and without a FPC, median time to occlusion was 51 and 6 months, respectively (P = 0.002). Using a multivariable Cox proportional hazards model, a FPC was associated with reduced odds of complete occlusion on last follow-up (risk ratio 0.35, 95% confidence interval 0.14–0.89; P = 0.029). Conclusions: Our results indicate reduced efficacy of FD for the treatment of PCOM aneurysms associated with a FPC. These findings may influence treatment selection for aneurysms at this location.

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