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The Role of Collateral Circulation in Branch Vessel Occlusion After Flow Diversion

Scott B Raymond1, Matthew J Koch2, James D Rabinov2

  • 1Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.

World Neurosurgery
|December 30, 2018
PubMed

Insights

Flow diversion for brain aneurysms can cover branch vessels, but collateral circulation protects against deficits. This study shows altered branch vessel flow after flow diversion is linked to collaterals, not ischemic injury.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Vascular Surgery

Background:

  • Flow diversion is a key treatment for intracranial aneurysms.
  • Covering adjacent branch vessels during flow diversion is common.
  • Clinical deficits from branch vessel occlusion are rare, suggesting protective mechanisms.

Purpose of the Study:

  • To investigate the role of collateral circulation in branch vessel occlusion during flow diversion.
  • To assess the relationship between collateral vessels, altered branch vessel flow, and clinical outcomes.

Main Methods:

  • Retrospective analysis of 84 patients undergoing flow diversion with the Pipeline embolization device (2011-2017).
  • Evaluation of transfemoral catheter angiograms (pre-treatment, post-treatment, follow-up) for branch vessel flow and collateral circulation.
  • Assessment of 142 covered branch vessels in 89 aneurysms, primarily in the anterior circulation.

Main Results:

  • Collateral circulation was present in approximately one-third of covered branch vessels.
  • Collateralization was associated with diminished or absent flow in follow-up angiography (P < 0.001).
  • Altered branch vessel flow was not linked to vascular risk factors, technique, or neurologic deficits.

Conclusions:

  • Altered flow in branch vessels covered during flow diversion is a marker of underlying collateral circulation.
  • This collateral compensation prevents downstream ischemic deficits, explaining the rarity of clinical complications.
Abstract

Keywords:
AneurysmBranch vesselCollateral circulationFlow diverter

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