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. 2023 Jul-Aug;34(4):168-176.
doi: 10.1016/j.neucie.2022.11.022. Epub 2023 Feb 9.

Endovascular treatment of posterior circulation aneurysms: Results from a single-team experience of 81 cases including 13 flow diversion treatment

Ilyas Dolas  1 , Tugrul Cem Unal  1 , Cafer Ikbal Gulsever  2 , Duran Sahin  1 , Heydar Huseynov  3 , Mehmet Barburoglu  4 , Onur Ozturk  5 , Halil Can  6 , Ali Ekrem Adiyaman  1 , Huseyin Emre Dagdeviren  1 , Pulat Akin Sabanci  1 , Aydin Aydoseli  1 , Yavuz Aras  1 , Altay Sencer  1 , Serra Sencer  4
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Endovascular treatment of posterior circulation aneurysms: Results from a single-team experience of 81 cases including 13 flow diversion treatment

Ilyas Dolas et al. Neurocirugia (Engl Ed). 2023 Jul-Aug.

Abstract

Introduction: Relatively constant surgical risks and rapid advances in endovascular treatment have caused a major shift toward endovascular management of posterior circulation aneurysms. This paper presents the results of a series of endovascularly treated posterior circulation aneurysms.

Methods: A total of 81 patients who underwent endovascular treatment of posterior circulation aneurysms performed by a single team between 2009 and 2019 were included. Demographic, clinical, radiologic, and management details were retrospectively obtained from hospital records.

Results: Among the included patients, 50 (61.7%) and 31 (38.3%) were female and male, respectively. Subarachnoid hemorrhage was observed in 30 patients (37%). Moreover, 40 (49.3%) aneurysms were treated with stent-assisted coiling, 1 (1.2%) aneurysm was treated with parent artery occlusion, 2 (2.4%) aneurysms were coiled using balloon assistance, 24 (29.6%) aneurysms were coiled primarily, 1 (1.2%) patient had an unsuccessful treatment attempt, and 13 (16.0%) aneurysms were treated with flow-diverter stents or stent monotherapy. During the last follow-up, 57 (83.8%) aneurysms were completely occluded, whereas 6 (8.8%) and 2 (2.9%) aneurysms did and did not have a residual neck, respectively. Flow diversion was used to treat 13 patients, among whom 8 had total occlusion or stable residue. A total of 7 deaths (8.6%) were encountered in this series.

Conclusion: Endovascular treatment should be considered as the primary treatment modality for posterior circulation aneurysms. Despite the high morbidity and mortality rates, promising results can be achieved with correct patient selection. Flow diversion can be a feasible alternative for complex aneurysms that are difficult to treat.

Keywords: Aneurisma; Aneurysm; Circulación posterior; Endovascular; Hemorragia subaracnoidea; Posterior circulation; Stent; Subarachnoid hemorrhage.

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