C A Taschner1, S Vedantham2, J de Vries3, A Biondi4, J Boogaarts5,3, N Sakai6, P Lylyk7, I Szikora8, S Meckel5, H Urbach5, P Kan9, R Siekmann10, J Bernardy5, M J Gounis11, A K Wakhloo12. 1. From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany christian.taschner@uniklinik-freiburg.de. 2. Department of Radiology (S.V.). 3. Department of Neurosurgery (J.d.V., J.B.), Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. 4. Department of Neuroradiology and Endovascular Therapy (A.B.), University of Besançon, Besançon, France. 5. From the Department of Neuroradiology (C.A.T., S.M., H.U., J.B.), Medical Centre-University of Freiburg, Freiburg, Germany. 6. Department of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Kobe, Japan. 7. Department of Neurosurgery (P.L.), Equipo de Neurocirugía Endovascular Radiología Intervencionista, Buenos Aires, Argentina. 8. National Institute of Neurosciences (I.S.), Budapest, Hungary. 9. Department of Neurosurgery (P.K.), Baylor College of Medicine, Houston, Texas. 10. Department of Neuroradiology (R.S.), Klinikum Kassel, Kassel, Germany. 11. New England Center for Stroke Research (M.J.G.). 12. Division of Neuroimaging and Intervention (A.K.W.), Departments of Radiology, Neurology, and Neurosurgery, University of Massachusetts Medical School, Worcester, Massachusetts.
Abstract
BACKGROUND AND PURPOSE: Flow diverters for the treatment of posterior circulation aneurysms remain controversial. We aimed to identify factors contributing to outcome measures in patients treated with the Surpass flow diverter for aneurysms in this location. MATERIALS AND METHODS: We conducted an observational study of 53 patients who underwent flow-diverter treatment for posterior circulation aneurysms at 15 centers. Key outcome measures were mortality, complete aneurysm occlusion, and modified Rankin Scale score at follow-up. RESULTS: At follow-up (median, 11.3 months; interquartile range, 5.9-12.7 months), 9 patients had died, resulting in an all-cause mortality rate of 17.3% (95% CI, 7%-27.6%); 7 deaths (14%) were directly related to the procedure and none occurred in patients with a baseline mRS score of zero. After adjusting for covariates, a baseline mRS of 3-5 was more significantly (P = .003) associated with a higher hazard ratio for death than a baseline mRS of 0-2 (hazard ratio, 17.11; 95% CI, 2.69-109.02). After adjusting for follow-up duration, a 1-point increase in the baseline mRS was significantly (P < .001) associated with higher values of mRS at follow-up (odds ratio, 2.93; 95% CI, 1.79-4.79). Follow-up angiography in 44 patients (median, 11.3 months; interquartile range, 5.9-12.7 months) showed complete aneurysm occlusion in 29 (66%; 95% CI, 50.1%-79.5%). CONCLUSIONS: Clinical results of flow-diverter treatment of posterior circulation aneurysms depend very much on patient selection. In this study, poorer outcomes were related to the treatment of aneurysms in patients with higher baseline mRS scores. Angiographic results showed a high occlusion rate for this subset of complex aneurysms.
BACKGROUND AND PURPOSE: Flow diverters for the treatment of posterior circulation aneurysms remain controversial. We aimed to identify factors contributing to outcome measures in patients treated with the Surpass flow diverter for aneurysms in this location. MATERIALS AND METHODS: We conducted an observational study of 53 patients who underwent flow-diverter treatment for posterior circulation aneurysms at 15 centers. Key outcome measures were mortality, complete aneurysm occlusion, and modified Rankin Scale score at follow-up. RESULTS: At follow-up (median, 11.3 months; interquartile range, 5.9-12.7 months), 9 patients had died, resulting in an all-cause mortality rate of 17.3% (95% CI, 7%-27.6%); 7 deaths (14%) were directly related to the procedure and none occurred in patients with a baseline mRS score of zero. After adjusting for covariates, a baseline mRS of 3-5 was more significantly (P = .003) associated with a higher hazard ratio for death than a baseline mRS of 0-2 (hazard ratio, 17.11; 95% CI, 2.69-109.02). After adjusting for follow-up duration, a 1-point increase in the baseline mRS was significantly (P < .001) associated with higher values of mRS at follow-up (odds ratio, 2.93; 95% CI, 1.79-4.79). Follow-up angiography in 44 patients (median, 11.3 months; interquartile range, 5.9-12.7 months) showed complete aneurysm occlusion in 29 (66%; 95% CI, 50.1%-79.5%). CONCLUSIONS: Clinical results of flow-diverter treatment of posterior circulation aneurysms depend very much on patient selection. In this study, poorer outcomes were related to the treatment of aneurysms in patients with higher baseline mRS scores. Angiographic results showed a high occlusion rate for this subset of complex aneurysms.
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