P-017 Fusiform vs non-fusiform posterior circulation aneurysms treated with flow diversion: a multicenter study
Notice bibliographique
Résumé
Introduction/Purpose Flow diverters have demonstrated reliable safety and effectiveness for the treatment of selected intracranial aneurysms (IAs) located mainly in the anterior circulation. Posterior circulation aneurysms comprise around 10-15% of all aneurysms. They have an increased risk of rupture compared to equal-sized lesions in the anterior circulation, higher rates of thromboembolic complications during and after treatment, and more complex anatomical configurations. Importantly, the risk for complications may differ substantially based on the aneurysm type. Hence, we aimed to evaluate the safety and effectiveness of FDs in posterior circulation fusiform [FIA] vs. non-fusiform [non-FIA] aneurysms. Materials and Methods We performed a multicenter, retrospective cohort study at 10 centers. All patients treated with FDs for aneurysms located in the posterior circulation (vertebral and basilar arteries) between 2015 and 2022 were included. Patients were divided into two groups according to the morphology of the aneurysm (FIA vs. non-FIA [saccular, blister, dissecting, mycotic]). The effectiveness outcome was measured by the rates of complete aneurysm occlusion using the Raymond-Roy classification at the latest follow-up. Safety outcomes included the incidence of ischemic/hemorrhagic and mortality. Results A total of 97 patients with 97 aneurysms were included. The fusiform group included 28 cases, and the non-FIA 69 (44 saccular, 22 dissecting, 2 blister, 1 mycotic). Median age (FIA, 58 years [46.5-64.5] vs. non-FIA, 61 [47.0-70.0]; p=.579), and female sex (FIA, 56% vs. non-FIA, 63%; p=.565) were not different. Clinical presentation and comorbidities were similar. The rates of premorbid disability (mRS 3-5: FIA, 18% vs. non-FIA, 3%; p=.001) were different. Previous endovascular treatment (p=.793) and location (vertebral artery: FIA, 57% vs. non-FIA, 59%; p=.900) were similar. We found significant differences in median aneurysm size (FIA, 17.0 mm [10.4-27.0] vs. non-FIA, 6.5 [3.4-9.8]; p=.001), and proximal (FIA, 2.8 mm [2.3-3.3] vs. non-FIA, 3.2 [2.4-4.0]; p=.023) and distal landing (FIA, 3.1 mm [2.6-3.8] vs. non-FIA, 3.7 [2.8-4.1]; p=.046) zones were significantly different. The most commonly implanted FD was Pipeline Flex (FIA, 50%, vs. non-FIA, 43%). FIAs had a higher mean FDs per patient (FIA, 1.6±1.3 vs. non-FIA, 1.1±0.1; p=.002) and adjunctive coiling (FIA, 96% vs. non-FIA, 76%; p=.025). There were no differences in the rates of procedural and intrahospital ischemic/hemorrhagic events (p=.534). Follow-up ischemic/hemorrhagic events (FIA, 14.5% vs. non-FIA, 5%; p=.074) were similar. However, there was an increased trend in the rate of mortality events in the FIA group (15%) vs. non-FIA (7%) (p=.246). The rate of complete occlusion was higher in the non-FIA (69% vs. FIA, 54%), but this difference was not statistically significant (p=.116). The overall median follow-up time of 11.6 [1.2-24.8] months. Conclusion We found that the treatment of posterior circulation FIAs with flow diversion had lowers rates of occlusion compared to non-FIA. The safety profile was lower than previously reported, suggesting the need for prospective studies to minimize non-adjudicated self-reporting bias on clinical outcomes. Disclosures J. Vivanco-Suarez: None. A. Rodriguez-Calienes: None. G. Cortez: None. H. Nishi: None. V. Pereira: None. M. Costa: None. C. Feigen: None. D. Altschul: None. S. Matsoukas: None. J. Fifi: None. M. Hafeez: None. P. Kan: None. A. Kühn: None. A. Puri: None. M. Rabinovic: None. A. Wakhloo: None. P. Khandelwal: None. Y. Lu: None. M. Galecio-Castillo: None. C. Alva: None. M. Farooqui: None. R. Hanel: None. S. Ortega-Gutierrez: None.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».