Failure of Flow Diverter Treatment of Intracranial Aneurysms Related to the Fetal-type Posterior Communicating Artery
PurposeThe pipeline embolization device (PED) is a flow diverter that has shown promise in the treatment of intracranial aneurysms. Close to one-fifth of aneurysms, however, fail to occlude after PED placement. This study aims to identify anatomical features and clinicopathologic factors that may pr...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Society of Interventional Neuroradiology
2015-09-01
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| Series: | Neurointervention |
| Subjects: | |
| Online Access: | http://neurointervention.org/upload/pdf/ni-10-60.pdf |
| _version_ | 1797330569022930944 |
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| author | Anderson Chun On Tsang Arthur Man Yuen Fung Frederick Chun Pong Tsang Gilberto Ka Kit Leung Raymand Lee Wai Man Lui |
| author_facet | Anderson Chun On Tsang Arthur Man Yuen Fung Frederick Chun Pong Tsang Gilberto Ka Kit Leung Raymand Lee Wai Man Lui |
| author_sort | Anderson Chun On Tsang |
| collection | DOAJ |
| description | PurposeThe pipeline embolization device (PED) is a flow diverter that has shown promise in the treatment of intracranial aneurysms. Close to one-fifth of aneurysms, however, fail to occlude after PED placement. This study aims to identify anatomical features and clinicopathologic factors that may predispose failed aneurysm occlusion with the PED.Materials and MethodsWe retrospectively reviewed all anterior circulation unruptured saccular aneurysms treated with the PED in a single-center. The primary outcome measure was angiographic occlusion. Anatomical features and potential predictors, including gender, aneurysm location, size, height, aspect ratio, neck width, prior treatment and the number of PED, were studied using binary logistic regression.Results29 anterior circulation unruptured saccular aneurysms with a mean size of 6.99 mm treated with the PED in a single center were retrospectively studied. The overall occlusion rate was 79.3% after a mean follow-up of 9.2 months. Four aneurysms were related to the fetal-type posterior communicating artery (PComA), and all were refractory to flow diverter treatment. Female gender was significantly associated with a higher occlusion rate. We present the anatomical features and propose possible pathophysiological mechanisms of these PComA aneurysms that failed flow diverter treatment.ConclusionA PComA aneurysm with persistent fetal-type circulation appears to be particularly refractory to flow diverter treatment, especially when the aneurysm incorporates a significant portion of the PComA. Our experience suggested that flow diverting stents alone may not be the ideal treatment for this subgroup of aneurysms, and alternative modalities should be considered. Female patients were found to have a significantly higher rate of treatment success. |
| first_indexed | 2024-03-08T07:21:39Z |
| format | Article |
| id | doaj.art-b7f5c91d82a043a1aab58285eb402169 |
| institution | Directory Open Access Journal |
| issn | 2093-9043 2233-6273 |
| language | English |
| last_indexed | 2024-03-08T07:21:39Z |
| publishDate | 2015-09-01 |
| publisher | Korean Society of Interventional Neuroradiology |
| record_format | Article |
| series | Neurointervention |
| spelling | doaj.art-b7f5c91d82a043a1aab58285eb4021692024-02-02T23:15:21ZengKorean Society of Interventional NeuroradiologyNeurointervention2093-90432233-62732015-09-01102606610.5469/neuroint.2015.10.2.6099Failure of Flow Diverter Treatment of Intracranial Aneurysms Related to the Fetal-type Posterior Communicating ArteryAnderson Chun On Tsang0Arthur Man Yuen Fung1Frederick Chun Pong Tsang2Gilberto Ka Kit Leung3Raymand Lee4Wai Man Lui5Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.Department of Radiology, Queen Mary Hospital, Hong Kong.Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.PurposeThe pipeline embolization device (PED) is a flow diverter that has shown promise in the treatment of intracranial aneurysms. Close to one-fifth of aneurysms, however, fail to occlude after PED placement. This study aims to identify anatomical features and clinicopathologic factors that may predispose failed aneurysm occlusion with the PED.Materials and MethodsWe retrospectively reviewed all anterior circulation unruptured saccular aneurysms treated with the PED in a single-center. The primary outcome measure was angiographic occlusion. Anatomical features and potential predictors, including gender, aneurysm location, size, height, aspect ratio, neck width, prior treatment and the number of PED, were studied using binary logistic regression.Results29 anterior circulation unruptured saccular aneurysms with a mean size of 6.99 mm treated with the PED in a single center were retrospectively studied. The overall occlusion rate was 79.3% after a mean follow-up of 9.2 months. Four aneurysms were related to the fetal-type posterior communicating artery (PComA), and all were refractory to flow diverter treatment. Female gender was significantly associated with a higher occlusion rate. We present the anatomical features and propose possible pathophysiological mechanisms of these PComA aneurysms that failed flow diverter treatment.ConclusionA PComA aneurysm with persistent fetal-type circulation appears to be particularly refractory to flow diverter treatment, especially when the aneurysm incorporates a significant portion of the PComA. Our experience suggested that flow diverting stents alone may not be the ideal treatment for this subgroup of aneurysms, and alternative modalities should be considered. Female patients were found to have a significantly higher rate of treatment success.http://neurointervention.org/upload/pdf/ni-10-60.pdffetal circulationflow divertersintracranial aneurysmoutcomepipeline embolization device |
| spellingShingle | Anderson Chun On Tsang Arthur Man Yuen Fung Frederick Chun Pong Tsang Gilberto Ka Kit Leung Raymand Lee Wai Man Lui Failure of Flow Diverter Treatment of Intracranial Aneurysms Related to the Fetal-type Posterior Communicating Artery Neurointervention fetal circulation flow diverters intracranial aneurysm outcome pipeline embolization device |
| title | Failure of Flow Diverter Treatment of Intracranial Aneurysms Related to the Fetal-type Posterior Communicating Artery |
| title_full | Failure of Flow Diverter Treatment of Intracranial Aneurysms Related to the Fetal-type Posterior Communicating Artery |
| title_fullStr | Failure of Flow Diverter Treatment of Intracranial Aneurysms Related to the Fetal-type Posterior Communicating Artery |
| title_full_unstemmed | Failure of Flow Diverter Treatment of Intracranial Aneurysms Related to the Fetal-type Posterior Communicating Artery |
| title_short | Failure of Flow Diverter Treatment of Intracranial Aneurysms Related to the Fetal-type Posterior Communicating Artery |
| title_sort | failure of flow diverter treatment of intracranial aneurysms related to the fetal type posterior communicating artery |
| topic | fetal circulation flow diverters intracranial aneurysm outcome pipeline embolization device |
| url | http://neurointervention.org/upload/pdf/ni-10-60.pdf |
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