title: Posterior circulation flow diversion: a single-center experience and literature review.
abstract: BACKGROUND
  Flow diverters have been used predominantly for large anterior circulation aneurysms. Data on the safety and efficacy of this treatment for posterior circulation aneurysms are limited.
  
  
  OBJECTIVE
  To present our posterior circulation flow diverter experience, outcomes and morbidity in comparison with recent studies.
  
  
  METHODS
  A retrospective chart and imaging review of six patients with seven aneurysms in posterior circulation vessels, treated with flow diverter technology was carried out. A literature review was performed using standard online search tools.
  
  
  RESULTS
  We included five saccular and two fusiform posterior circulation aneurysms. An average of two flow diverters was placed for each patient. Adjunctive coiling was used in three cases. Follow-up at an average of 14.5 months showed complete angiographic occlusion in 4 (57.1%) cases, including one patient with in-stent thrombosis and major brainstem stroke at 4.5 months, a week after self-discontinuing dual antiplatelet therapy. Two other patients developed small periprocedural strokes but had excellent recovery. One death occurred 18 months after the initial procedure. No aneurysm rupture or parenchymal hemorrhage was seen. Overall, 5 (71%) cases, all with saccular aneurysms, had good clinical outcome (modified Rankin score (mRS) 0-1). Fusiform basilar aneurysms had markedly worse outcomes (mRS 5 and 6). Our literature review yielded six other studies with 100 additional patients. Overall, good outcome was seen in 74.3%, with a 12.3% average mortality and 11% permanent neurologic deficit rate. Complete occlusion varied from 43% to 100%.
  
  
  CONCLUSIONS
  Flow diversion may be a possible treatment in carefully selected patients with high-risk atypical posterior circulation aneurysms, with poor natural history and no optimal treatment strategy. Symptomatic and fusiform large aneurysms appear to carry the highest risk. Further studies are necessary to assess the role of flow diversion in the posterior circulation.
authors.affiliation: Cleveland Clinic, Cerebrovascular Center, Cleveland, Ohio, USA.
authors.forename: Gabor
authors.initials: G
authors.lastname: Toth
authors.affiliation: Cleveland Clinic, Cerebrovascular Center, Cleveland, Ohio, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bain
authors.affiliation: Cleveland Clinic, Cerebrovascular Center, Cleveland, Ohio, USA.
authors.forename: M Shazam
authors.initials: MS
authors.lastname: Hussain
authors.affiliation: Neurosurgical Associates PC, Richmond, Virginia, USA.
authors.forename: Shaye
authors.initials: S
authors.lastname: Moskowitz
authors.affiliation: Cleveland Clinic, Cerebrovascular Center, Cleveland, Ohio, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Masaryk
authors.affiliation: Cleveland Clinic, Cerebrovascular Center, Cleveland, Ohio, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Rasmussen
authors.affiliation: Cleveland Clinic, Cerebrovascular Center, Cleveland, Ohio, USA.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Hui
mesh_terms: D000328:Adult; D002560:Cerebrovascular Circulation; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies
keywords: Aneurysm; Blood Flow; Flow Diverter; Posterior fossa