• Lorenzo Rinaldo, Waleed Brinjikji, Harry Cloft, Giuseppe Lanzino, L Fernando Gonzalez, Peter Kan, and Leonardo Rangel Castilla.
• Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: Rinaldo.Lorenzo@Mayo.Edu.
• World Neurosurg. 2019 Jul 1; 127: e1232-e1236.

BackgroundFlow diversion (FD) has emerged as an effective treatment modality for aneurysms of the posterior communicating artery (PCOM). Whether or not a fetal posterior circulation (FPC) affects PCOM aneurysm occlusion rates after FD remains undetermined.MethodsWe performed a retrospective cohort study in which treatment outcomes for FD of PCOM aneurysms from multiple institutions were reviewed. The primary outcome of interest was complete aneurysm occlusion at last follow-up. The presence of a FPC, defined as a PCOM diameter larger than that of the P1 segment, was noted and its relationship to complete aneurysm occlusion was investigated using a Cox proportional hazards model.ResultsThere were 49 patients with 49 PCOM aneurysms treated with FD who met inclusion criteria for analysis. A FPC was present in 16 patients (32.7%). Complete aneurysm occlusion was observed in 34 patients (69.4%). Complete occlusion was less common for patients with a FPC (43.7% vs. 81.8%; P = 0.007). For patients with and without a FPC, median time to occlusion was 51 and 6 months, respectively (P = 0.002). Using a multivariable Cox proportional hazards model, a FPC was associated with reduced odds of complete occlusion on last follow-up (risk ratio 0.35, 95% confidence interval 0.14-0.89; P = 0.029).ConclusionsOur results indicate reduced efficacy of FD for the treatment of PCOM aneurysms associated with a FPC. These findings may influence treatment selection for aneurysms at this location.Copyright © 2019 Elsevier Inc. All rights reserved.

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