Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study

N. Adeeb; M. Dibas; C. J. Griessenauer; H. H. Cuellar; M. M. Salem; S. Xiang; A. Enriquez-Marulanda; T. Hong; H. Zhang; P. Taussky; R. Grandhi; M. Waqas; A. S. Aldine; V. M. Tutino; A. Aslan; A. H. Siddiqui; E. I. Levy; C. S. Ogilvy; A. J. Thomas; C. Ulfert; M. A. Möhlenbruch; L. Renieri; J. D.Bengzon Diestro; G. Lanzino; W. Brinjikji; J. Spears; J. E. Vranic; R. W. Regenhardt; J. D. Rabinov; P. Harker; E. Müller-Thies-broussalis; M. Killer-Oberpfalzer; C. Islak; N. Kocer; M. Sonnberger; T. Engelhorn; A. Kapadia; V. X.D. Yang; A. Salehani; M. R. Harrigan; T. Krings; C. C. Matouk; S. Mirshahi; K. S. Chen; M. A. Aziz-Sultan; M. Ghorbani; C. M. Schirmer; O. Goren; S. S. Dalal; T. Finkenzeller; M. Holtmannspötter; J. H. Buhk; P. M. Foreman; M. C. Cress; R. A. Hirschl; W. Reith; A. Simgen; H. Janssen; T. R. Marotta; C. J. Stapleton; A. B. Patel; A. A. Dmytriw

doi:10.3174/ajnr.A7679

Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study

N. Adeeb, M. Dibas, C. J. Griessenauer, H. H. Cuellar, M. M. Salem, S. Xiang, A. Enriquez-Marulanda, T. Hong, H. Zhang, P. Taussky, R. Grandhi, M. Waqas, A. S. Aldine, V. M. Tutino, A. Aslan, A. H. Siddiqui, E. I. Levy, C. S. Ogilvy, A. J. Thomas, C. UlfertM. A. Möhlenbruch, L. Renieri, J. D.Bengzon Diestro, G. Lanzino, W. Brinjikji, J. Spears, J. E. Vranic, R. W. Regenhardt, J. D. Rabinov, P. Harker, E. Müller-Thies-broussalis, M. Killer-Oberpfalzer, C. Islak, N. Kocer, M. Sonnberger, T. Engelhorn, A. Kapadia, V. X.D. Yang, A. Salehani, M. R. Harrigan, T. Krings, C. C. Matouk, S. Mirshahi, K. S. Chen, M. A. Aziz-Sultan, M. Ghorbani, C. M. Schirmer, O. Goren, S. S. Dalal, T. Finkenzeller, M. Holtmannspötter, J. H. Buhk, P. M. Foreman, M. C. Cress, R. A. Hirschl, W. Reith, A. Simgen, H. Janssen, T. R. Marotta, C. J. Stapleton, A. B. Patel, A. A. Dmytriw

Radiology

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND AND PURPOSE: Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS: A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS: A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34). CONCLUSIONS: This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.

Original language	English (US)
Pages (from-to)	1615-1620
Number of pages	6
Journal	American Journal of Neuroradiology
Volume	43
Issue number	11
DOIs	https://doi.org/10.3174/ajnr.A7679
State	Published - Nov 1 2022

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Clinical Neurology

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10.3174/ajnr.A7679

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Adeeb, N., Dibas, M., Griessenauer, C. J., Cuellar, H. H., Salem, M. M., Xiang, S., Enriquez-Marulanda, A., Hong, T., Zhang, H., Taussky, P., Grandhi, R., Waqas, M., Aldine, A. S., Tutino, V. M., Aslan, A., Siddiqui, A. H., Levy, E. I., Ogilvy, C. S., Thomas, A. J., ... Dmytriw, A. A. (2022). Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study. American Journal of Neuroradiology, 43(11), 1615-1620. https://doi.org/10.3174/ajnr.A7679

Adeeb, N, Dibas, M, Griessenauer, CJ, Cuellar, HH, Salem, MM, Xiang, S, Enriquez-Marulanda, A, Hong, T, Zhang, H, Taussky, P, Grandhi, R, Waqas, M, Aldine, AS, Tutino, VM, Aslan, A, Siddiqui, AH, Levy, EI, Ogilvy, CS, Thomas, AJ, Ulfert, C, Möhlenbruch, MA, Renieri, L, Diestro, JDB, Lanzino, G, Brinjikji, W, Spears, J, Vranic, JE, Regenhardt, RW, Rabinov, JD, Harker, P, Müller-Thies-broussalis, E, Killer-Oberpfalzer, M, Islak, C, Kocer, N, Sonnberger, M, Engelhorn, T, Kapadia, A, Yang, VXD, Salehani, A, Harrigan, MR, Krings, T, Matouk, CC, Mirshahi, S, Chen, KS, Aziz-Sultan, MA, Ghorbani, M, Schirmer, CM, Goren, O, Dalal, SS, Finkenzeller, T, Holtmannspötter, M, Buhk, JH, Foreman, PM, Cress, MC, Hirschl, RA, Reith, W, Simgen, A, Janssen, H, Marotta, TR, Stapleton, CJ, Patel, AB & Dmytriw, AA 2022, 'Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study', American Journal of Neuroradiology, vol. 43, no. 11, pp. 1615-1620. https://doi.org/10.3174/ajnr.A7679

@article{c9b867c235394d888c35d86520e0841a,

title = "Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study",

abstract = "BACKGROUND AND PURPOSE: Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS: A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS: A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34). CONCLUSIONS: This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.",

author = "N. Adeeb and M. Dibas and Griessenauer, {C. J.} and Cuellar, {H. H.} and Salem, {M. M.} and S. Xiang and A. Enriquez-Marulanda and T. Hong and H. Zhang and P. Taussky and R. Grandhi and M. Waqas and Aldine, {A. S.} and Tutino, {V. M.} and A. Aslan and Siddiqui, {A. H.} and Levy, {E. I.} and Ogilvy, {C. S.} and Thomas, {A. J.} and C. Ulfert and M{\"o}hlenbruch, {M. A.} and L. Renieri and Diestro, {J. D.Bengzon} and G. Lanzino and W. Brinjikji and J. Spears and Vranic, {J. E.} and Regenhardt, {R. W.} and Rabinov, {J. D.} and P. Harker and E. M{\"u}ller-Thies-broussalis and M. Killer-Oberpfalzer and C. Islak and N. Kocer and M. Sonnberger and T. Engelhorn and A. Kapadia and Yang, {V. X.D.} and A. Salehani and Harrigan, {M. R.} and T. Krings and Matouk, {C. C.} and S. Mirshahi and Chen, {K. S.} and Aziz-Sultan, {M. A.} and M. Ghorbani and Schirmer, {C. M.} and O. Goren and Dalal, {S. S.} and T. Finkenzeller and M. Holtmannsp{\"o}tter and Buhk, {J. H.} and Foreman, {P. M.} and Cress, {M. C.} and Hirschl, {R. A.} and W. Reith and A. Simgen and H. Janssen and Marotta, {T. R.} and Stapleton, {C. J.} and Patel, {A. B.} and Dmytriw, {A. A.}",

year = "2022",

month = nov,

day = "1",

doi = "10.3174/ajnr.A7679",

language = "English (US)",

volume = "43",

pages = "1615--1620",

journal = "American Journal of Neuroradiology",

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TY - JOUR

T1 - Learning Curve for Flow Diversion of Posterior Circulation Aneurysms

T2 - A Long-Term International Multicenter Cohort Study

AU - Adeeb, N.

AU - Dibas, M.

AU - Griessenauer, C. J.

AU - Cuellar, H. H.

AU - Salem, M. M.

AU - Xiang, S.

AU - Enriquez-Marulanda, A.

AU - Hong, T.

AU - Zhang, H.

AU - Taussky, P.

AU - Grandhi, R.

AU - Waqas, M.

AU - Aldine, A. S.

AU - Tutino, V. M.

AU - Aslan, A.

AU - Siddiqui, A. H.

AU - Levy, E. I.

AU - Ogilvy, C. S.

AU - Thomas, A. J.

AU - Ulfert, C.

AU - Möhlenbruch, M. A.

AU - Renieri, L.

AU - Diestro, J. D.Bengzon

AU - Lanzino, G.

AU - Brinjikji, W.

AU - Spears, J.

AU - Vranic, J. E.

AU - Regenhardt, R. W.

AU - Rabinov, J. D.

AU - Harker, P.

AU - Müller-Thies-broussalis, E.

AU - Killer-Oberpfalzer, M.

AU - Islak, C.

AU - Kocer, N.

AU - Sonnberger, M.

AU - Engelhorn, T.

AU - Kapadia, A.

AU - Yang, V. X.D.

AU - Salehani, A.

AU - Harrigan, M. R.

AU - Krings, T.

AU - Matouk, C. C.

AU - Mirshahi, S.

AU - Chen, K. S.

AU - Aziz-Sultan, M. A.

AU - Ghorbani, M.

AU - Schirmer, C. M.

AU - Goren, O.

AU - Dalal, S. S.

AU - Finkenzeller, T.

AU - Holtmannspötter, M.

AU - Buhk, J. H.

AU - Foreman, P. M.

AU - Cress, M. C.

AU - Hirschl, R. A.

AU - Reith, W.

AU - Simgen, A.

AU - Janssen, H.

AU - Marotta, T. R.

AU - Stapleton, C. J.

AU - Patel, A. B.

AU - Dmytriw, A. A.

PY - 2022/11/1

Y1 - 2022/11/1

N2 - BACKGROUND AND PURPOSE: Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS: A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS: A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34). CONCLUSIONS: This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.

AB - BACKGROUND AND PURPOSE: Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS: A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS: A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34). CONCLUSIONS: This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.

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JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

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ER -

Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study

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