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DOI: 10.1055/s-0043-1778085
It Is Necessary to Pay Attention to Where the Pcom Originate from the Aneurysm to Treat with FD
Funding None.
Abstract
Objective With the expansion of indications of flow diverter (FD) for cerebral aneurysms, FD placement for posterior communicating artery (Pcom) aneurysms has been approved. However, it is controversial whether Pcom aneurysms should be treated with FD or not. In this study, we report the outcome of FD treatment for Pcom aneurysms in Japan.
Materials and Methods We retrospectively analyzed 36 patients with 38 aneurysms treated with FD placement for Pcom aneurysms between 2015 and 2021 in our hospital. We divided our cases into complete occlusion (CO) and non-CO groups. And we extracted contributing factors to CO using multivariate analysis. We also compared the complications rate among the three types of FDs.
Results CO was obtained in 29 cases (79.3%), and complications were observed in 3 cases (7.9%). Multivariate analysis revealed that the type of Pcom branch from the aneurysmal dome was a significant factor contributing to CO (odds ratio: 0.0052, 95% confidence interval 0.000048–0.584, p = 0.029). In terms of complications, complication rate was significantly higher in the Flow-Redirection Endoluminal Device (FRED) group (p = 0.0491).
Conclusion The outcome for Pcom aneurysms treated by FD was acceptable. When treating, we must pay attention to where Pcom originates. Achieving CO with FD is difficult for aneurysms where the Pcom branches from the dome. Furthermore, when treating Pcom aneurysms with FRED, it is necessary to be careful about thromboembolic complications.
Ethical Approval
The study was approved by the Institutional Review Board of Juntendo University, Graduate of School of Medicine (E22–0005-H01). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standers.
Patient Consent
For this type of study, patient consent is not required.
Authors' Contributions
T.F. was involved in conceptualization, methodology, formal analysis and investigation, and writing-original draft preparation. K.T., Y.M.M, and T.K. were involved in methodology. K.W., and A.K. supervised the study. H.O. was involved in review and editing, resources, and supervision.
Publication History
Article published online:
27 May 2024
© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Nieuwkamp DJ, Setz LE, Algra A, Linn FHH, de Rooij NK, Rinkel GJE. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol 2009; 8 (07) 635-642
- 2 Morita A, Kirino T, Hashi K. et al; UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012; 366 (26) 2474-2482
- 3 Wiebers DO, Whisnant JP, Huston III J. et al; International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362 (9378) 103-110
- 4 Nelson PK, Lylyk P, Szikora I, Wetzel SG, Wanke I, Fiorella D. The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol 2011; 32 (01) 34-40
- 5 Becske T, Kallmes DF, Saatci I. et al. Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology 2013; 267 (03) 858-868
- 6 Oishi H, Teranishi K, Yatomi K, Fujii T, Yamamoto M, Arai H. Flow diverter therapy using a pipeline embolization device for 100 unruptured large and giant internal carotid artery aneurysms in a single center in a Japanese population. Neurol Med Chir (Tokyo) 2018; 58 (11) 461-467
- 7 Kallmes DF, Hanel R, Lopes D. et al. International retrospective study of the pipeline embolization device: a multicenter aneurysm treatment study. AJNR Am J Neuroradiol 2015; 36 (01) 108-115
- 8 Rinaldo L, Brinjikji W, Cloft H. et al. Effect of fetal posterior circulation on efficacy of flow diversion for treatment of posterior communicating artery aneurysms: a multi-institutional study. World Neurosurg 2019; 127: e1232-e1236
- 9 Kan P, Duckworth E, Puri A, Velat G, Wakhloo A. Treatment failure of fetal posterior communicating artery aneurysms with the pipeline embolization device. J Neurointerv Surg 2016; 8 (09) 945-948
- 10 Brinjikji W, Kallmes DF, Cloft HJ, Lanzino G. Age-related outcomes following intracranial aneurysm treatment with the Pipeline Embolization Device: a subgroup analysis of the IntrePED registry. J Neurosurg 2016; 124 (06) 1726-1730
- 11 Adeeb N, Moore JM, Wirtz M. et al. Predictors of incomplete occlusion following pipeline embolization of intracranial aneurysms: is it less effective in older patients?. AJNR Am J Neuroradiol 2017; 38 (12) 2295-2300
- 12 Roy AK, Howard BM, Haussen DC. et al. Reduced efficacy of the pipeline embolization device in the treatment of posterior communicating region aneurysms with fetal posterior cerebral artery configuration. Neurosurgery 2018; 82 (05) 695-700
- 13 Saeki N, Rhoton Jr AL. N. S. Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis. J Neurosurg 1977; 46 (05) 563-578
- 14 Rhoton Jr AL. The supratentorial arteries. Neurosurgery 2002; 51 (4, suppl): S53-S120
- 15 Kulcsár Z, Houdart E, Bonafé A. et al. Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 2011; 32 (01) 20-25