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Research ArticleNeurointervention

Flow Diversion of Posterior Circulation Aneurysms: Systematic Review of Disaggregated Individual Patient Data

A. Alwakeal, N.A. Shlobin, P. Golnari, W. Metcalf-Doetsch, P. Nazari, S.A. Ansari, M.C. Hurley, D.R. Cantrell, A. Shaibani, B.S. Jahromi and M.B. Potts
American Journal of Neuroradiology October 2021, 42 (10) 1827-1833; DOI: https://doi.org/10.3174/ajnr.A7220
A. Alwakeal
aFrom the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
bDepartment of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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N.A. Shlobin
aFrom the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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P. Golnari
aFrom the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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W. Metcalf-Doetsch
aFrom the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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P. Nazari
aFrom the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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S.A. Ansari
aFrom the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
bDepartment of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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M.C. Hurley
aFrom the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
bDepartment of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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D.R. Cantrell
bDepartment of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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A. Shaibani
aFrom the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
bDepartment of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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B.S. Jahromi
aFrom the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
bDepartment of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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M.B. Potts
aFrom the Department of Neurological Surgery (A.A., N.A.S., P.G., W.M.-D., P.N., S.A.A., M.C.H., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
bDepartment of Radiology (A.A., S.A.A., M.C.H., D.R.C., A.S., B.S.J., M.B.P.), Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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    FIG 1.

    A, Final posterior circulation aneurysm locations included the extradural vertebral artery (eVA), intradural vertebral artery (iVA), proximal PICA (pPICA), distal PICA (dPICA), VBJ, basilar trunk (BT), basilar apex (BA), and the PCA. B, Proportion of major complications by aneurysm location. C, Proportion of angiographic occlusions by aneurysm location. D, Proportion of good functional outcomes (defined as mRS 0–2) by aneurysm location.

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    FIG 2.

    Overall long-term neurologic outcomes based on the mRS score. The asterisk indicates patients who did not have a reported neurologic outcome but had angiographic follow-up and were designated as alive.

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    FIG 3.

    Meta-analysis of studies reporting flow diversion for posterior circulation aneurysms with ≥10 patients. A, Forest plot comparing the proportion of patients in each study with a reported major complication. The pooled incidence of major complications among 712 patients was 19.6%, with a heterogeneity I2 = 42.9%. B, Funnel plot of the included studies reporting major complications. C, Forest plot comparing angiographic aneurysm occlusion for the included studies. The pooled incidence of complete angiographic occlusion among 594 patients was 75.2%, with a heterogeneity I2 = 77.9%. D, Funnel plot of the included studies reporting angiographic outcomes.

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American Journal of Neuroradiology: 42 (10)
American Journal of Neuroradiology
Vol. 42, Issue 10
1 Oct 2021
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Cite this article
A. Alwakeal, N.A. Shlobin, P. Golnari, W. Metcalf-Doetsch, P. Nazari, S.A. Ansari, M.C. Hurley, D.R. Cantrell, A. Shaibani, B.S. Jahromi, M.B. Potts
Flow Diversion of Posterior Circulation Aneurysms: Systematic Review of Disaggregated Individual Patient Data
American Journal of Neuroradiology Oct 2021, 42 (10) 1827-1833; DOI: 10.3174/ajnr.A7220

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Flow Diversion of Posterior Circulation Aneurysms: Systematic Review of Disaggregated Individual Patient Data
A. Alwakeal, N.A. Shlobin, P. Golnari, W. Metcalf-Doetsch, P. Nazari, S.A. Ansari, M.C. Hurley, D.R. Cantrell, A. Shaibani, B.S. Jahromi, M.B. Potts
American Journal of Neuroradiology Oct 2021, 42 (10) 1827-1833; DOI: 10.3174/ajnr.A7220
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