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Japanese Journal of Radiology
Published in: Japanese Journal of Radiology 8/2023

15-03-2023 | Aneurysm | Original Article

Utility of flow diverters in treatment of acutely ruptured uncoilable aneurysms of the posterior circulation of the brain

Authors: Halitcan Batur, Jeremy Lynch, Bige Sayin, Shahram Derakhshani, Ilkay Akmangit, Ergun Daglioglu, Anil Arat

Published in: Japanese Journal of Radiology | Issue 8/2023

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Abstract

Purpose

Aim of this study is to evaluate safety and efficacy of flow diverters (FDs) in treatment of acutely ruptured posterior circulation aneurysms

Materials and methods

Databases of three participating institutions were retrospectively scanned for patients in whom FD placement was attempted for treatment of acutely ruptured vertebrobasilar aneurysms. An interval of 14 days or fewer between the latest ictus and treatment was used as inclusion criterion. Patients with dolichoectasia of vertebrobasilar arteries were excluded. If necessary, adjunctive techniques including coiling or stenting were utilized. Clinical outcomes were graded using mWFNS (modified World Federation of Neurosurgical Societies Scale) and mRS (modified Rankin Scale). Aneurysmal occlusion was defined as Raymond-Roy Class 1. Spearman’s (ρ) test was used to assess the correlation between variables. Univariate and multivariate logistic regression were used to assess outcomes.

Results

31 patients (25 women, mean age: 52.7 ± 15.2) harboring 32 aneurysms (16 non-saccular, mean size: 11.4 ± 7 mm) were included. Mean number of FDs used was 1.22 ± 0.42. In six cases, adjunctive coiling and in five cases, apposing stent placement were used. Overall mortality rate and procedure-related mortality rates were 22.5% (7/31) and 9.6% (3/31), respectively. At a mean imaging follow-up of 17.2 ± 12.6 months, total occlusion was achieved in 22 aneurysms (91.6%). Univariate analysis showed that mortality was positively correlated with vasospasm (ρ = 0.600, p < 0.05), higher mWFNS Scale (ρ = 0.685, p < 0.05), higher modified Fischer Score (ρ = 0.609, p < 0.05), higher mRS (ρ = 0.594, p < 0.05) on admission and negatively correlated with saccular morphology (ρ = −0.529, p < 0.05). Multivariate logistic regression identified mWFNS on admission as a significant predictor. (OR: 7.148, 95% CI 1.777–28.758, p: 0.01). Adjunctive coiling positively correlated with aneurysm occlusion. (ρ = 0.522, p < 0.05).

Conclusion

The procedure-related morbidity and mortality is not negligible. However, the risks and efficacy associated with FDs are acceptable, especially when adjunctive coiling is possible, given the lack of treatment alternatives.
Appendix
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Metadata
Title
Utility of flow diverters in treatment of acutely ruptured uncoilable aneurysms of the posterior circulation of the brain
Authors
Halitcan Batur
Jeremy Lynch
Bige Sayin
Shahram Derakhshani
Ilkay Akmangit
Ergun Daglioglu
Anil Arat
Publication date
15-03-2023
Publisher
Springer Nature Singapore
Keywords
Aneurysm
Aneurysm
Published in
Japanese Journal of Radiology / Issue 8/2023
Print ISSN: 1867-1071
Electronic ISSN: 1867-108X
DOI
https://doi.org/10.1007/s11604-023-01409-y

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