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

被引：10

作者：

Adeeb, N. ^{[1
,2
]}

Dibas, M. ^{[1
,2
]}

Griessenauer, C. J. ^{[3
,4
,5
]}

Cuellar, H. H. ^{[1
,2
]}

Salem, M. M. ^{[6
]}

Xiang, S. ^{[8
]}

Enriquez-Marulanda, A. ^{[6
]}

Hong, T. ^{[8
]}

Zhang, H. ^{[8
]}

Taussky, P. ^{[6
,9
]}

Grandhi, R. ^{[9
]}

Waqas, M. ^{[10
]}

Aldine, A. S. ^{[1
,2
]}

Tutino, V. M. ^{[10
]}

Aslan, A. ^{[1
,2
]}

Siddiqui, A. H. ^{[10
]}

Levy, E., I ^{[10
]}

Ogilvy, C. S. ^{[6
]}

Thomas, A. J. ^{[7
]}

Ulfert, C. ^{[11
]}

Mohlenbruch, M. A. ^{[11
]}

Renieri, L. ^{[12
]}

Diestro, J. D. Bengzon ^{[13
]}

Lanzino, G. ^{[14
]}

Brinjikji, W. ^{[14
]}

Spears, J. ^{[13
]}

Vranic, J. E. ^{[25
,26
]}

Regenhardt, R. W. ^{[25
,26
]}

Rabinov, J. D. ^{[25
,26
]}

Harker, P. ^{[25
,26
]}

Mueller-Thies-Broussalis, E. ^{[5
]}

Killer-Oberpfalzer, M. ^{[5
]}

Islak, C. ^{[15
]}

Kocer, N. ^{[15
]}

Sonnberger, M. ^{[16
]}

Engelhorn, T. ^{[17
]}

Kapadia, A. ^{[18
,19
]}

Yang, V. X. D. ^{[20
,21
]}

Salehani, A. ^{[22
]}

Harrigan, M. R. ^{[22
]}

Krings, T. ^{[23
]}

Matouk, C. C. ^{[24
]}

Mirshahi, S. ^{[25
,26
]}

Chen, K. S. ^{[25
,26
]}

Aziz-Sultan, M. A. ^{[25
,26
]}

Ghorbani, M. ^{[27
]}

Schirmer, C. M. ^{[3
,4
]}

Goren, O. ^{[3
,4
]}

Dalal, S. S. ^{[3
,4
]}

Finkenzeller, T. ^{[28
]}

机构：

[1] Louisiana State Univ Hosp, Dept Neurosurg, 1501 Kings Highway, Shreveport, LA 71104 USA

[2] Louisiana State Univ Hosp, Dept Intervent Neuroradiol, 1501 Kings Highway, Shreveport, LA 71104 USA

[3] Geisinger, Dept Neurosurg, Danville, PA USA

[4] Geisinger, Dept Radiol, Danville, PA USA

[5] Paracelsus Med Univ, Univ Hosp Salzburg, Dept Neurol, Inst Neurointervent, Salzburg, Austria

[6] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Neurosurg Serv, Boston, MA 02115 USA

[7] Rowan Univ, Cooper Med Sch, Cooper Univ Hlth Care, Dept Neurol Surg, Camden, NJ USA

[8] Capital Med Univ, Xuanwu Hosp, Dept Neurosurg, Beijing, Peoples R China

[9] Univ Utah, Dept Neurosurg, Salt Lake City, UT USA

[10] SUNY Buffalo, Dept Neurosurg, Buffalo, NY USA

[11] Univ Klinikum Heidelberg, Dept Neuroradiol, Heidelberg, Germany

[12] Univ Florence, Dept Intervent Neuroradiol, Florence, Italy

[13] St Michaels Hosp, Div Diagnost & Therapeut Neuroradiol, Toronto, ON, Canada

[14] Mayo Clin, Dept Neurol Surg, Rochester, MN USA

[15] Istanbul Univ, Cerrahpasa Med Sch, Dept Neuroradiol, Istanbul, Turkey

[16] Kepler Univ Klinikum Linz, Dept Neuroradiol, Linz, Austria

[17] Univ Hosp Erlangen, Dept Neuroradiol, Erlangen, Germany

[18] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med Imaging, Toronto, ON, Canada

[19] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Neurosurg, Toronto, ON, Canada

[20] Western Univ, London Hlth Sci Ctr, Dept Med Imaging, Neurointervent Program, London, ON, Canada

[21] Western Univ, London Hlth Sci Ctr, Dept Clin Neurol Sci, Neurointervent Program, London, ON, Canada

[22] Univ Alabama Birmingham, Dept Neurosurg, Birmingham, AL USA

[23] Univ Hlth Network, Toronto Western Hosp, Div Intervent Neuroradiol, Toronto, ON, Canada

[24] Yale Sch Med, Dept Neurosurg, New Haven, CT USA

[25] Harvard Med Sch, Massachusetts Gen Hosp, Neurcendovasc Program, Boston, MA 02115 USA

[26] Harvard Med Sch, Brigham & Womens Hosp, Boston, MA 02115 USA

[27] Iran Univ Med Sci, Firoozgar Hosp, Div Vasc & Endovasc Neurosurg, Tehran, Iran

[28] Paracelsus Med Univ Nuernberg, Klinikum Nuernberg Sued, Inst Radiol & Neuroradiol, Nurnberg, Germany

[29] Klinikum Weiden, Dept Neuroradiol, Weiden, Germany

[30] Univ Hosp Hamburg Eppendorf, Dept Neuroradiol, Hamburg, Germany

[31] Orlando Hlth, Neurosci & Rehabil Inst, Orlando, FL USA

[32] Univ Klinikum Saarlandes, Clink Diagnost & Intervent Neuroradiol, Homburg, Germany

[33] Kinikum Ingolstadt, Inst Neuroradiol, Ingolstadt, Germany

来源：

AMERICAN JOURNAL OF NEURORADIOLOGY | 2022年 / 43卷 / 11期

关键词：

PIPELINE EMBOLIZATION DEVICE; COMPLICATIONS; PLACEMENT; DIVERTORS;

D O I：

10.3174/ajnr.A7679

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：1615 / 1620

页数：6

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