Abstract：
BACKGROUND: Flow diversion for bifurcation aneurysms requires excluding one of the branches from the parent artery, raising concern for ischemic events. We evaluated thromboembolic events and their relationship with covering the origin of the posterior cerebral artery (PCA).
METHODS: This retrospective analysis included patients with confirmed basilar and proximal PCA aneurysms treated with flow diversion between 2013 and 2023. Procedures were classified according to the coverage of the origin of the PCA. Thromboembolic events associated with the excluded PCA were evaluated.
RESULTS: Of the total 28 aneurysms included, 7 were at the basilar tip, 16 in the basilar trunk, and 5 in the first segment of the PCA; 15 were treated by excluding one of the PCAs. Dual antiplatelet therapy included aspirin and ticagrelor (57.1%), aspirin and clopidogrel (35.7%), or aspirin and prasugrel (3.57%). Complete and near-complete aneurysm occlusion was achieved in 80.8% of the aneurysms treated at a median follow-up of 12.31 months. Thromboembolic complications occurred in 3 patients (2 with basilar perforator stroke and 1 with basilar in-stent thrombosis). However, the difference in these events was not statistically significant between patients with PCA coverage and those without (P = 0.46). Diminished flow and a lack of flow was seen in 8 and 7 of the covered vessels, respectively. A modified Rankin scale score of ≤2 was reported for 89.3% of patients at a median clinical follow-up of 5.5 months.
CONCLUSIONS: The incidence of thromboembolic events is high in distal basilar and proximal PCA aneurysms; however, PCA coverage was not associated with their occurrence. There was no difference in postprocedural disability between patients whose aneurysms were treated by excluding one of the PCAs and those who were not.
METHODS: This retrospective analysis included patients with confirmed basilar and proximal PCA aneurysms treated with flow diversion between 2013 and 2023. Procedures were classified according to the coverage of the origin of the PCA. Thromboembolic events associated with the excluded PCA were evaluated.
RESULTS: Of the total 28 aneurysms included, 7 were at the basilar tip, 16 in the basilar trunk, and 5 in the first segment of the PCA; 15 were treated by excluding one of the PCAs. Dual antiplatelet therapy included aspirin and ticagrelor (57.1%), aspirin and clopidogrel (35.7%), or aspirin and prasugrel (3.57%). Complete and near-complete aneurysm occlusion was achieved in 80.8% of the aneurysms treated at a median follow-up of 12.31 months. Thromboembolic complications occurred in 3 patients (2 with basilar perforator stroke and 1 with basilar in-stent thrombosis). However, the difference in these events was not statistically significant between patients with PCA coverage and those without (P = 0.46). Diminished flow and a lack of flow was seen in 8 and 7 of the covered vessels, respectively. A modified Rankin scale score of ≤2 was reported for 89.3% of patients at a median clinical follow-up of 5.5 months.
CONCLUSIONS: The incidence of thromboembolic events is high in distal basilar and proximal PCA aneurysms; however, PCA coverage was not associated with their occurrence. There was no difference in postprocedural disability between patients whose aneurysms were treated by excluding one of the PCAs and those who were not.
摘要：
背景：分叉动脉瘤的流量转移（FD）需要从父动脉中排除其中一个分支，提高对缺血事件的关注。在这里，我们评估了血栓栓塞事件及其与覆盖大脑后动脉（PCA）起源的关系。
方法：这项回顾性分析包括在2013年至2023年间接受FD治疗的确认基底和近端PCA动脉瘤的患者。根据PCA起源的覆盖范围对程序进行分类。评估与排除的PCA相关的血栓栓塞事件。
结果：在总共28个动脉瘤中，7个在基底尖端，16在基底干，P1段为5；15个被处理，不包括一个PCA。DAPT包括阿司匹林替格瑞洛（57.1%），阿司匹林-氯吡格雷（35.7%），和阿司匹林-普拉格雷(3.57%)。在12.31个月的中位随访中，80.8％的动脉瘤达到了完全和接近完全的动脉瘤闭塞。3例患者发生血栓栓塞并发症,2例基底动脉穿支卒中和1例基底动脉支架内血栓形成;但有PCA覆盖的患者和无PCA覆盖的患者在这些事件中没有统计学差异(p=0.46).在八艘和七艘有盖船只中，流量减少且缺乏。在中位5.5个月的临床随访中,有89.3%的患者报告mRS≤2.
结论：远端基底动脉瘤和近端PCA动脉瘤的血栓栓塞事件较高，但PCA覆盖率与它们的发生无关。在不包括其中一个PCAs的动脉瘤治疗的患者之间，术后残疾没有差异。和那些没有的人。
方法：这项回顾性分析包括在2013年至2023年间接受FD治疗的确认基底和近端PCA动脉瘤的患者。根据PCA起源的覆盖范围对程序进行分类。评估与排除的PCA相关的血栓栓塞事件。
结果：在总共28个动脉瘤中，7个在基底尖端，16在基底干，P1段为5；15个被处理，不包括一个PCA。DAPT包括阿司匹林替格瑞洛（57.1%），阿司匹林-氯吡格雷（35.7%），和阿司匹林-普拉格雷(3.57%)。在12.31个月的中位随访中，80.8％的动脉瘤达到了完全和接近完全的动脉瘤闭塞。3例患者发生血栓栓塞并发症,2例基底动脉穿支卒中和1例基底动脉支架内血栓形成;但有PCA覆盖的患者和无PCA覆盖的患者在这些事件中没有统计学差异(p=0.46).在八艘和七艘有盖船只中，流量减少且缺乏。在中位5.5个月的临床随访中,有89.3%的患者报告mRS≤2.
结论：远端基底动脉瘤和近端PCA动脉瘤的血栓栓塞事件较高，但PCA覆盖率与它们的发生无关。在不包括其中一个PCAs的动脉瘤治疗的患者之间，术后残疾没有差异。和那些没有的人。
