Abu-Fares Omar, Adamou Antonis, Raab Peter, Lanfermann Heinrich, Sirakov Alexander, Middendorff Marie, Hounchonou Harold F, Krauss Joachim K, Al-Afif Shadi
Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Germany.
Radiology Department, UH St Ivan Rilski, Bulgaria.
Neuroradiol J. 2025 Aug 27:19714009251373070. doi: 10.1177/19714009251373070.
IntroductionPosterior circulation aneurysms are particularly challenging to treat due to their anatomical complexity and the high perforator density within this region. The pipeline vantage flow diverter (PVFD) has shown promising results in treating anterior circulation aneurysms. However, its efficacy and safety in treating posterior circulation saccular aneurysms are not well investigated.MethodsSingle-center study reviewed patients with posterior circulation aneurysms treated with the PVFD between September 2021 and March 2024. Patients and aneurysm characteristics, clinical results, and radiological results were documented.Results22 patients harboring 24 aneurysms were identified. All aneurysms had a saccular morphology. Complications included ischemic events in two patients (8.3%), one leading to mRS deterioration from 0 to 3. One cerebral hemorrhage leading to mRS shift from 0 to 1 was also documented. At the latest imaging follow-up available (median 14.3 months), complete aneurysm occlusion (Class I, Raymond-Roy occlusion classification (RROC) was achieved in 50% of the cases, residual neck (Class II) in 41.7%, and residual aneurysm (Class III) in 8.3%. Basilar bifurcation aneurysms had lower complete occlusion rates (RROC I: 33.3%) and higher complication rates (16.7% with mRS shift) compared to other locations. In-stent stenosis was rare (4.5%). A limitation of the study is the retrospective, single-center study design.ConclusionThe PVFD demonstrates high occlusion rates and a favorable safety profile in the treatment of saccular aneurysms in the posterior circulation. However, treatment of basilar bifurcation aneurysms with the PVFD remains challenging due to the complex anatomy and high-flow dynamics in this location.
引言
后循环动脉瘤因其解剖结构复杂以及该区域内穿支血管密度高，治疗起来极具挑战性。管道优势血流转向装置（PVFD）在治疗前循环动脉瘤方面已显示出有前景的结果。然而，其在治疗后循环囊状动脉瘤中的疗效和安全性尚未得到充分研究。
方法
单中心研究回顾了2021年9月至2024年3月期间接受PVFD治疗的后循环动脉瘤患者。记录了患者和动脉瘤的特征、临床结果及影像学结果。
结果
共识别出22例患者，其患有24个动脉瘤。所有动脉瘤均为囊状形态。并发症包括2例患者发生缺血事件（8.3%），其中1例导致改良Rankin量表（mRS）评分从0恶化至3。还记录了1例脑出血导致mRS评分从0转变为1。在最新的影像学随访（中位时间14.3个月）时，50%的病例实现了动脉瘤完全闭塞（I级，雷蒙德 - 罗伊闭塞分类（RROC）），41.7%为残余颈部（II级），8.3%为残余动脉瘤（III级）。与其他部位相比，基底动脉分叉处动脉瘤的完全闭塞率较低（RROC I：33.3%），并发症发生率较高（mRS评分转变的为16.7%）。支架内狭窄罕见（4.5%）。本研究的一个局限性是回顾性的单中心研究设计。
结论
PVFD在治疗后循环囊状动脉瘤方面显示出高闭塞率和良好的安全性。然而，由于该部位解剖结构复杂和血流动力学特点，使用PVFD治疗基底动脉分叉处动脉瘤仍然具有挑战性。
