E-265 Determinants of clinical, functional and angiographic outcomes of posterior circulation aneurysms treated with flow diversion: a multicenter experience
Bibliographic record
Abstract
Introduction The use of flow diversion (FD) for posterior circulation intracranial aneurysms (IAs) has expanded over the years. The study aimed to evaluate determinants of angiographic outcomes (complete IA aneurysm occlusion) and functional and safety outcomes at last follow-up for posterior circulation IAs treated with FD. Methods Data was obtained from the multicentric observational retrospective North American registry for posterior circulation aneurysms treated with FD (Post-FD). This registry included all consecutive patients treated with FD for posterior circulation aneurysms at 10 academic institutions between May 2014 and November 2022. All unruptured and ruptured saccular, fusiform, or dissecting aneurysms in the posterior circulation were included in this study. Univariable and multivariable mixed effects models were used to find determinants of complete occlusion, functional independence (modified Rankin Scale 0–2) and composite safety outcome (major ischemic/hemorrhagic stroke and/or procedure related mortality). Results This study included 198 patients and IAs (median age 58 years, IQR 49–66; male to female ratio 1:1.2). Determinants of complete occlusion included increased age (aOR: 0.97, 95% CI: 0.95 - 0.99, p=0.042), basilar location (aOR: 0.23, 95% CI: 0.10 - 0.56, p=0.001), bifurcation position (aOR: 0.27, 95% CI: 0.08 - 0.91, p=0.034) and increased IAs size (aOR: 0.97, 95% CI: 0.93 - 0.99, p=0.047). Having functional independence at baseline (aOR: 15.86, 95% CI: 3.85 - 65.28, p<0.001) and lower IAs size (aOR: 0.96, 95% CI: 0.93 - 0.99, p=0.017) were associated with higher chances of functional independence. Basilar IAs (OR: 4.01, 95% CI: 1.48 - 10.90, p=0.006) and the number of implanted FD with more >1 implanted FD (OR: 3.18, 95% CI: 1.15 - 8.81, p=0.026) were significantly associated with more rates of composite safety outcome. Conclusion Our results shed light on the important determinants of outcomes including age, IAs’ location, position and size, and number of implanted FD. We urge for careful selection of IAs for FD implantation to obtain optimum outcomes. Disclosures M. Dibas: None. A. Rodriguez-Calienes: None. J. Vivanco-Suarez: None. G. Cortez: None. V. Pereira: 2; C; Stryker, Medtronic, Penumbra, Neurovasc, and Balt. H. Nishi: None. G. Toth: 2; C; Medtronic and Dynamed. T. Patterson: None. D. Altschul: 2; C; Microvention, Stryker, and Von Vascular Inc. C. Feigen: None. M. Essibayi: None. M. Galecio-Castillo: None. J. Fifi: 1; C; Viz. Investor/Stoker: Imperative care and Cerebrotech. 2; C; Penumbra, Stryker, Microvention, and Cerenovus. S. Matsoukas: None. P. Kan: 1; C; NIH, Siemens, Joe Niekro, and Medtronic. 2; C; Stryker, Imperative Care, Cerenovus, and Microvention. M. Hafeez: None. A. Puri: 1; C; Medtronic, Stryker, and Cerenovus. 2; C; Medtronic, Stryker, Cerenovus, Microvention, Agile, Merit, Corindus, Q’apel, Arsenal, and Imperative Care. A. Kuhn: None. A. Wakhloo: None. M. Rabinovich: None. P. Khandelwal: 2; C; Stryker and Medtronic. E. Sauvageau: None. A. Aghaebrahim: None. M. Costa: None. S. Monteith: None. R. Hanel: 1; C; NIH, Interline Endowment, Microvention, Stryker, and CNX. Investor/Stoker: InNeuroCo, Cerebrotech, eLum, Endostream, Three Rivers Medical Inc., Scientia, RisT, BlinkTBI, and Corindus. 2; C; Medtronic, Stryker, Cerenovous, Microvention, Balt, Phenox, Rapid Medical, and Q’Apel. 6; C; MiVI, eLum, Three Rivers Medical Inc., Shape Medical, and Corindus. S. Ortega-Gutierrez: 1; C; NIH-NINDS (R01NS127114–01, RO3NS126804–01), Stryker, Medtronic, Microvention, Methinks, Viz.ai. 2; C; Medtronic, Stryker Neurovascular.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".