{
  "abstract": "Introduction Flow diversion using the Pipeline Embolization Device (PED) has been increasingly used off-label for treatment of posterior circulation aneurysms. Prior series have shown complications of disabling brainstem infarct, especially in large fusiform, dolichoectatic aneurysms. The incidence of brainstem infarct after PED placement for non-fusiform, saccular aneurysms in the posterior circulation has not been well-demonstrated. We describe a series of patients with saccular posterior circulation aneurysms treated with PED, paying special attention to the incidence of brainstem perforator infarct and elucidating the factors which precipitated such events.Methods Patients with saccular basilar apex (BA) and superior cerebellar artery (SCA) aneurysms treated with PED during 2016-2024 were reviewed retrospectively. Demographics, aneurysm characteristics, treatment characteristics, thromboembolic complications, and occlusion rates were reviewed.Results 17 patients with saccular BA and SCA aneurysms were reviewed. Median age at treatment was 62 years, and most patients were female ( n=15, 88.2%). 9 patients (52.9%) had history of rupture with prior treatment and presented for treatment of recurrence or remnant neck. Aneurysm sizes ranged from 2-22mm. All patients were placed on dual antiplatelets after PED placement and received P2Y12 platelet function testing prior to or after placement. 6 of 16 patients with follow-up (37.5%) had full occlusion of the aneurysm on last documented follow-up (mean follow-up 24 months).One patient suffered a pontine infarct two weeks post-treatment. Diagnostic angiogram at time of presentation showed a delay in filling of the correlating pontine perforator artery. Review of DYNA-CT images obtained during the index treatment shows that the perforator in question had been partially covered by the proximal free-end of the PED construct. The patient ultimately recovered with no residual symptoms, and the aneurysm was fully occluded at last follow-up.Discussion Flow diversion for saccular BA and SCA aneurysms may be a safe treatment alternative in select patients. In our cohort, only one of 16 patients (6.3%) suffered a brainstem stroke which is like related to technical aspects of placing the device rather than an inherent quality of the vertebrobasilar system which predisposes it to perforator infarct after PED placement. The efficacy of aneurysm occlusion in our series is comparable with prior series describing flow diversion for saccular aneurysms in the posterior circulation. Further large-cohort studies are required to evaluate the safety and efficacy of flow diversion for saccular aneurysms in the posterior circulation.Disclosures J. Ryoo: None. E. Nossek: None. C. Rutledge: None.Abstract E-188 Figure 1Pontine perforator artery stroke 2 weeks post-treatment. (a) 72 axial MRI showing stroke distribution. (b) Cone-beam CT reconstruction post-embolization showing the pontine perforator in question (yellow arrow) partially covered by the flow diverter. The contra lateral pontine perforator, in comparison, is fully covered",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, New York University, New York, NY"
      ],
      "name": "J Ryoo"
    },
    {
      "affiliations": [
        "Neurosurgery, New York University, New York, NY"
      ],
      "name": "E Nossek"
    },
    {
      "affiliations": [
        "Neurosurgery, New York University, New York, NY"
      ],
      "name": "C Rutledge"
    }
  ],
  "title": "E-188 Brainstem stroke risk after flow-diversion for saccular posterior circulation aneurysm",
  "uid": "763549b3-4f8d-5611-a855-8969fb102ecb"
}