• Cordell Baker, Ramesh Grandhi, Christoph J Griessenauer, Adam A Dmytriw, Anish Kapadia, Yang Victor X D VXD Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada., Mohammad Ghorbani, Karen Chen, Mohammad A Aziz-Sultan, Lorenzo Rinaldo, Giuseppe Lanzino, Waleed Brinjikji, and Philipp Taussky.
• Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.
• World Neurosurg. 2020 Nov 1; 143: e523-e528.

BackgroundHemorrhagic vascular lesions in the posterior cerebral circulation such as ruptured aneurysms and dissections can be challenging to treat. Flow diversion has become an important off-label option, but few studies have analyzed the safety of these devices in this setting. Using an international, multicenter cohort, we reviewed posterior circulation subarachnoid hemorrhage (SAH) patients treated with the Pipeline Embolization Device (PED) in the acute setting and assessed the incidence of Takotsubo cardiomyopathy (TCM).MethodsEleven neurovascular centers were queried to identify cases of posterior circulation aneurysms or dissections treated with the PED in the acute setting of SAH. Among those, 5 centers had cases that matched the inclusion criteria. The following variables were evaluated: demographics, the location and morphology of the aneurysm, the clinical presentation, the specific form of treatment, complications including the development of TCM, antiplatelet medication regimen, and follow-up time.ResultsA total of 23 patients were treated with PED after posterior circulation SAH, and 13% of these developed TCM. The lesions were the result of hemorrhagic intracranial dissection (8 patients), ruptured pseudoaneurysm (3), ruptured saccular aneurysm (7), blister aneurysm (4), and fusiform aneurysm (1). Ninety-one percent of patients had complete or near-complete aneurysm occlusion on follow-up imaging. Five patients died in the perioperative period; 16/18 survivors had a favorable outcome.ConclusionsWe describe an unexpectedly high incidence of TCM after the placement of PEDs in patients with posterior circulation SAH in our large case series. Further studies will be needed to elucidate possible causes.Copyright © 2020 Elsevier Inc. All rights reserved.

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