Thromboembolic Events in the Posterior Circulation After Flow Diversion—A Closer Look at Coverage of the Posterior Cerebral Artery

Flow diversion for bifurcation aneurysms requires excluding one of the branches from the parent artery, raising concern for ischemic events. We evaluated thromboembolic events and their relationship with covering the origin of the posterior cerebral artery (PCA). This retrospective analysis included...

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Veröffentlicht in:World neurosurgery 2024-07, Vol.187, p.e920-e928
Hauptverfasser: Ramirez-Velandia, Felipe, Enriquez-Marulanda, Alejandro, Filo, Jean, Young, Michael, Fodor, Thomas B., Sconzo, Daniel, Muram, Sandeep, Granstein, Justin H., Shutran, Max, Taussky, Philipp, Ogilvy, Christopher S.
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container_issue
container_start_page e920
container_title World neurosurgery
container_volume 187
creator Ramirez-Velandia, Felipe
Enriquez-Marulanda, Alejandro
Filo, Jean
Young, Michael
Fodor, Thomas B.
Sconzo, Daniel
Muram, Sandeep
Granstein, Justin H.
Shutran, Max
Taussky, Philipp
Ogilvy, Christopher S.
description Flow diversion for bifurcation aneurysms requires excluding one of the branches from the parent artery, raising concern for ischemic events. We evaluated thromboembolic events and their relationship with covering the origin of the posterior cerebral artery (PCA). This retrospective analysis included patients with confirmed basilar and proximal PCA aneurysms treated with flow diversion between 2013 and 2023. Procedures were classified according to the coverage of the origin of the PCA. Thromboembolic events associated with the excluded PCA were evaluated. Of the total 28 aneurysms included, 7 were at the basilar tip, 16 in the basilar trunk, and 5 in the first segment of the PCA; 15 were treated by excluding one of the PCAs. Dual antiplatelet therapy included aspirin and ticagrelor (57.1%), aspirin and clopidogrel (35.7%), or aspirin and prasugrel (3.57%). Complete and near-complete aneurysm occlusion was achieved in 80.8% of the aneurysms treated at a median follow-up of 12.31 months. Thromboembolic complications occurred in 3 patients (2 with basilar perforator stroke and 1 with basilar in-stent thrombosis). However, the difference in these events was not statistically significant between patients with PCA coverage and those without (P = 0.46). Diminished flow and a lack of flow was seen in 8 and 7 of the covered vessels, respectively. A modified Rankin scale score of ≤2 was reported for 89.3% of patients at a median clinical follow-up of 5.5 months. The incidence of thromboembolic events is high in distal basilar and proximal PCA aneurysms; however, PCA coverage was not associated with their occurrence. There was no difference in postprocedural disability between patients whose aneurysms were treated by excluding one of the PCAs and those who were not.
doi_str_mv 10.1016/j.wneu.2024.05.011
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subjects Adult
Aged
Basilar tip
Bifurcation aneurysm
Disability
Endovascular Procedures - methods
Female
Flow diversion
Humans
Intracranial Aneurysm - surgery
Male
Middle Aged
Platelet Aggregation Inhibitors - therapeutic use
Posterior cerebral artery
Posterior Cerebral Artery - surgery
Posterior circulation
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Retrospective Studies
Stents
Thromboembolic complications
Thromboembolism - epidemiology
Thromboembolism - etiology
title Thromboembolic Events in the Posterior Circulation After Flow Diversion—A Closer Look at Coverage of the Posterior Cerebral Artery
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