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

N Adeeb¹, M Dibas², C J Griessenauer^{3

4}, H H Cuellar², M M Salem⁵, S Xiang⁶, A Enriquez-Marulanda⁵, T Hong⁷, H Zhang⁷, P Taussky^{5

8}, R Grandhi⁸, M Waqas⁹, A S Aldine¹, V M Tutino⁹, A Aslan², A H Siddiqui⁹, E I Levy⁹, C S Ogilvy⁵, A J Thomas¹⁰, C Ulfert¹¹, M A Möhlenbruch¹¹, L Renieri¹², J D Bengzon Diestro¹³, G Lanzino¹⁴, W Brinjikji¹⁴, J Spears¹³, J E Vranic¹⁵, R W Regenhardt¹⁵, J D Rabinov¹⁵, P Harker¹⁵, E Müller-Thies-Broussalis⁴, M Killer-Oberpfalzer⁴, C Islak¹⁶, N Kocer¹⁶, M Sonnberger¹⁷, T Engelhorn¹⁸, A Kapadia¹⁹, V X D Yang²⁰, A Salehani²¹, M R Harrigan²¹, T Krings²², C C Matouk²³, S Mirshahi¹⁵, K S Chen¹⁵, M A Aziz-Sultan¹⁵, M Ghorbani²⁴, C M Schirmer³, O Goren³, S S Dalal²⁵, T Finkenzeller²⁶, M Holtmannspötter^{26

27}, J-H Buhk²⁸, P M Foreman²⁹, M C Cress²⁹, R A Hirschl²⁹, W Reith³⁰, A Simgen³⁰, H Janssen³¹, T R Marotta¹³, C J Stapleton¹⁵, A B Patel¹⁵, A A Dmytriw^{20

15}

Affiliations

¹ From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana nimer_adeeb@hotmail.com.
² From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana.
³ Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania.
⁴ Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
⁵ Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
⁶ Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China nimer_adeeb@hotmail.com.
⁷ Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China.
⁸ Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah.
⁹ Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York.
¹⁰ Department of Neurological Surgery (A.J.T.), Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey.
¹¹ Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany.
¹² Department of Interventional Neuroradiology (L.R.), University of Florence, Florence, Italy.
¹³ Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada.
¹⁴ Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota.
¹⁵ Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
¹⁶ Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
¹⁷ Department of Neuroradiology (M.S.), Kepler Universitätsklinikum Linz, Linz, Austria.
¹⁸ Department of Neuroradiology (T.E.), University Hospital Erlangen, Erlangen, Germany.
¹⁹ Departments of Medical Imaging and Neurosurgery (A.K.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
²⁰ Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada.
²¹ Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama.
²² Division of Interventional Neuroradiology (T.K.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
²³ Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, Connecticut.
²⁴ Division of Vascular and Endovascular Neurosurgery (M.G.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
²⁵ Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania nimer_adeeb@hotmail.com.
²⁶ Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany.
²⁷ Department of Neuroradiology (M.H.), Klinikum Weiden, Weiden, Germany.
²⁸ Department of Neuroradiology (J.-H.B.), University Hospital Hamburg Eppendorf, Hamburg, Germany.
²⁹ Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida.
³⁰ Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
³¹ Institute for Neuroradiology (H.J.), Klinikum Ingolstadt, Ingolstadt, Germany nimer_adeeb@hotmail.com.

PMID: 36229166
PMCID: PMC9731249
DOI: 10.3174/ajnr.A7679

Multicenter Study

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

N Adeeb et al. AJNR Am J Neuroradiol. 2022 Nov.

. 2022 Nov;43(11):1615-1620.

doi: 10.3174/ajnr.A7679. Epub 2022 Oct 13.

Authors

Affiliations

¹ From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana nimer_adeeb@hotmail.com.
² From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana.
³ Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania.
⁴ Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
⁵ Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
⁶ Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China nimer_adeeb@hotmail.com.
⁷ Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China.
⁸ Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah.
⁹ Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York.
¹⁰ Department of Neurological Surgery (A.J.T.), Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey.
¹¹ Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany.
¹² Department of Interventional Neuroradiology (L.R.), University of Florence, Florence, Italy.
¹³ Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada.
¹⁴ Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota.
¹⁵ Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
¹⁶ Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
¹⁷ Department of Neuroradiology (M.S.), Kepler Universitätsklinikum Linz, Linz, Austria.
¹⁸ Department of Neuroradiology (T.E.), University Hospital Erlangen, Erlangen, Germany.
¹⁹ Departments of Medical Imaging and Neurosurgery (A.K.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
²⁰ Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada.
²¹ Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama.
²² Division of Interventional Neuroradiology (T.K.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
²³ Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, Connecticut.
²⁴ Division of Vascular and Endovascular Neurosurgery (M.G.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
²⁵ Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania nimer_adeeb@hotmail.com.
²⁶ Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany.
²⁷ Department of Neuroradiology (M.H.), Klinikum Weiden, Weiden, Germany.
²⁸ Department of Neuroradiology (J.-H.B.), University Hospital Hamburg Eppendorf, Hamburg, Germany.
²⁹ Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida.
³⁰ Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
³¹ Institute for Neuroradiology (H.J.), Klinikum Ingolstadt, Ingolstadt, Germany nimer_adeeb@hotmail.com.

PMID: 36229166
PMCID: PMC9731249
DOI: 10.3174/ajnr.A7679

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.

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References

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

Affiliations

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

Authors

Affiliations

Abstract

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References

Publication types

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LinkOut - more resources

Full Text Sources

Medical