• Adam N Wallace, Jonathan A Grossberg, Almandoz Josser E Delgado JED Division of Neurointerventional Radi-ology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota., Mudassar Kamran, Anil K Roy, Yasha Kayan, Matthew J Austin, Brian M Howard, Christopher J Moran, C Michael Cawley, DeWitte T Cross, Jacques E Dion, Akash P Kansagra, and Joshua W Osbun.
• Division of Neurointerventional Radi-ology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
• Neurosurgery. 2018 Oct 1; 83 (4): 790-799.

BackgroundFlow diversion of posterior cerebral artery (PCA) aneurysms has not been widely reported, possibly owing to concerns regarding parent vessel size and branch vessel coverage.ObjectiveTo examine the safety and effectiveness of PCA aneurysm flow diverter treatment.MethodsRetrospective review of PCA aneurysms treated with the Pipeline Embolization Device (PED; Medtronic Inc, Dublin, Ireland) at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes. Systematic review of the literature identified published reports of PCA aneurysms treated with flow diversion. Rates of aneurysm occlusion and complications were calculated, and outcomes of saccular and fusiform aneurysm treatments were compared.ResultsTen PCA aneurysms in 9 patients were treated with the PED. There were 2 intraprocedural thromboembolic events (20%), including 1 symptomatic infarction and 1 delayed PED thrombosis. Eight of 10 patients returned to or improved from their baseline functional status. Complete aneurysm occlusion with parent vessel preservation was achieved in 75% (6/8) of cases at mean follow-up of 16.7 mo. Eleven of 12 (92%) major branch vessels covered by a PED remained patent. Including the present study, systematic review of 15 studies found a complete aneurysm occlusion rate of 88% (30/34) and complication rate of 26% (10/38), including 5 symptomatic ischemic strokes (13%; 5/38). Fusiform aneurysms more frequently completely occluded compared with saccular aneurysms (100% vs 70%; P = .03) but were associated with a higher complication rate (43% vs 9%; P = .06).ConclusionThe safety and effectiveness profile of flow diverter treatment of PCA aneurysms may be acceptable in select cases.

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