Long-term Outcomes of Flow Diverters for Branch-Incorporated Aneurysms

The understanding of long-term outcomes associated with branch-incorporated aneurysms treated using a flow diverter (FD) remains limited. This study evaluated long-term outcomes of flow diversion in patients with branch-incorporated aneurysms.

We performed a retrospective analysis of a prospectively maintained database from 5 centers in South Korea. Patients who underwent FD placement for unruptured aneurysms with incorporated branch artery were identified; and long-term clinical and angiographic outcomes were evaluated.

Sixty-five patients (median age, 61 years; male-to-female ratio, 15:50) with aneurysms (median size: 11.1 mm; median neck diameter: 7.2 mm) were identified. The median duration of clinical and imaging follow-up was 38 months (range: 13-75 months) and 26 months (range: 6-50 months), respectively. All patients exhibited favorable outcomes, with 63 having mRS scores of 0-1 and 2 having an mRS score of 2. Aneurysm occlusion was achieved in 29.2% (n=19) of patients at 6-8 months postoperatively, 53.8% (n=35) at 12-18 months postoperatively, 84.0% (n=42) at 19-48 months postoperatively, and 86.5% (n=45) at >48 months postoperatively. The incorporated branches were patent with aneurysm occlusion in 40% (n=26), patent with aneurysm remnants in 36.9% (n=24), and occluded with aneurysm occlusion in 23% (n=15) of patients at the latest follow-up. No aneurysm recanalized after occlusion was achieved.

FD for branch-incorporated aneurysms demonstrated a low aneurysm occlusion rate in the short- to intermediate-term (6-12 months). However, long-term occlusion rates were comparable with those reported in the literature. In 23% of patients, the incorporated branches were occluded along with the aneurysm; none of these resulted in a permanent neurologic deficit.