Safety and efficacy of the pipeline vantage flow diverter for the treatment of saccular aneurysms in the posterior cerebral circulation.

IntroductionPosterior circulation aneurysms are particularly challenging to treat due to their anatomical complexity and the high perforator density within this region. The pipeline vantage flow diverter (PVFD) has shown promising results in treating anterior circulation aneurysms. However, its efficacy and safety in treating posterior circulation saccular aneurysms are not well investigated.MethodsSingle-center study reviewed patients with posterior circulation aneurysms treated with the PVFD between September 2021 and March 2024. Patients and aneurysm characteristics, clinical results, and radiological results were documented.Results22 patients harboring 24 aneurysms were identified. All aneurysms had a saccular morphology. Complications included ischemic events in two patients (8.3%), one leading to mRS deterioration from 0 to 3. One cerebral hemorrhage leading to mRS shift from 0 to 1 was also documented. At the latest imaging follow-up available (median 14.3 months), complete aneurysm occlusion (Class I, Raymond-Roy occlusion classification (RROC) was achieved in 50% of the cases, residual neck (Class II) in 41.7%, and residual aneurysm (Class III) in 8.3%. Basilar bifurcation aneurysms had lower complete occlusion rates (RROC I: 33.3%) and higher complication rates (16.7% with mRS shift) compared to other locations. In-stent stenosis was rare (4.5%). A limitation of the study is the retrospective, single-center study design.ConclusionThe PVFD demonstrates high occlusion rates and a favorable safety profile in the treatment of saccular aneurysms in the posterior circulation. However, treatment of basilar bifurcation aneurysms with the PVFD remains challenging due to the complex anatomy and high-flow dynamics in this location.