The Panacea or the Problem: Flow Diverters in the Treatment of Fusiform Vertebrobasilar Aneurysms

Keywords: aneurysm, blood flow, endovascular therapy, basilar artery, endovascular stent

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     The use of flow-diverting stents has gained momentum as a curative approach in the treatment of complex intracranial aneurysms, including formidable lesions of the posterior circulation.
     Here we report the significant morbidity and mortality encountered with flow-diversion in the treatment of vertebrobasilar aneurysms at our institution.
     Six patients underwent treatment for fusiform vertebrobasilar aneurysms with flow diverters.
     The authors retrospectively reviewed their prospectively collected endovascular database to identify patients who underwent treatment of intracranial aneurysms with flow-diverting devices. Outcomes scored by modifed Rankin scale score (mRS) were tabulated as were the complications experienced.
      Of these, Pipeline devices (ev3/Covidien Vascular Therapies, Mansfield, Massachusetts) were placed in five patients and Silk devices (Balt Extrusion, Montmorency, France) in one patient. At the last follow-up evaluation, three patients had died (mRS of 6), all of whom were treated with the Pipeline. The other three patients had achieved mRS scores of 5 (severe disability), 1, and 0, respectively.
     This is a retrospective study.
     Flow diversion for fusiform vertebrobasilar aneurysms is not without significant morbidity and mortality.
     As outcomes data slowly becomes available for patients receiving these devices for fusiform posterior circulation aneurysms, practitioners should be aware that these devices may not necessarily be the answer for the treatment of these malignant lesions.


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