Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study

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FIGURE.
The rates of thromboembolic and hemorrhagic complications during the study years.

Table 1:

Change in treatment outcome with time^{^a}

	2011–2013	2014–2015	2016–2017	2018–2019	P Value	Total (n = 378)
	(n = 76)	(n = 118)	(n = 94)	(n = 90)	P Value	Total (n = 378)
Last follow-up imaging lapsed time (months)^{^b}	14.0 [28.8]	24.0 [24.0]	14.0 [16.5]	6.80 [5.00]	<.001	13.0 [20.6]
Last follow-up clinical time from treatment (months)^{^c}	22.5 [40.5]	29.0 [29.0]	17.0 [17.3]	6.50 [6.00]	<.001	13.0 [24.0]
Follow-up occlusion rate^{^d}
Complete occlusion (100%)	47 (66.2%)	75 (68.9%)	69 (77.5%)	46 (67.7%)	.273	237 (70.3%)
Incomplete occlusion (<90%)	15 (21.1%)	14 (12.8%)	7 (7.9%)	12 (17.6%)		48 (14.2%)
Near-complete occlusion (90%–99%)	9 (12.7%)	20 (18.3%)	13 (14.6%)	10 (14.7%)		52 (15.4%)
Retreatment^{^e}	9 (12.2%)	13 (11.2%)	5 (5.4%)	3 (3.5%)	.092	30 (8.2%)
mRS on last follow-up^{^f}
0–2	66 (88.0%)	96 (84.2%)	82 (87.2%)	78 (88.6%)	.793	322 (86.8%)
3–6	9 (12.0%)	18 (15.8%)	12 (12.8%)	10 (11.4%)		49 (13.2%)
Follow-up mRS^{^f}
Improved	23 (30.7%)	28 (24.6%)	21 (22.3%)	10 (11.4%)	.034	82 (22.1%)
No change	40 (53.3%)	65 (57.0%)	58 (61.7%)	68 (77.2%)		231 (62.3%)
Worsened	12 (16.0%)	21 (18.4%)	15 (16.0%)	10 (11.4%)		58 (15.6%)
Neurologic complications
Thromboembolic	12 (15.8%)	19 (16.1%)	10 (10.6%)	8 (8.9%)	.342	49 (13.0%)
Thromboembolic (symptomatic)	9 (11.8%)	14 (11.9%)	3 (3.2%)	7 (7.8%)	.107	33 (8.7%)
Hemorrhagic	5 (6.6%)	5 (4.2%)	4 (4.3%)	3 (3.3%)	.781	17 (4.5%)
Hemorrhagic (symptomatic)	3 (3.9%)	4 (3.4%)	3 (3.2%)	3 (3.3%)	.994	13 (3.4%)
Other procedural related complications	7 (9.2%)	9 (7.6%)	4 (4.3%)	5 (5.6%)	.57	25 (6.6%)
Mortality^{^f}	6 (8.0%)	9 (7.9%)	5 (5.3%)	6 (6.8%)	.881	26 (7.0%)

↵a Continuous variables are presented as median [IQR]. Otherwise, data are No. (%).
↵b Data missing for 46 patients.
↵c Data missing for 56 patients.
↵d Data missing for 41 patients.
↵e Data missing for 10 patients.
↵f Data missing for 7 patients.

Table 2:

Predictors of thromboembolic complications^{^a}

	Thromboembolic Complications
	Univariable	Multivariable
Age (yr)	1.00 (0.98–1.03, P = .811)
Sex
Female	Ref
Male	0.97 (0.53–1.76, P = .910)
Smoking	1.39 (0.64–2.87, P = .381)
Pretreatment mRS
0–2	Ref	Ref
3–5	3.13 (1.48–6.38, P = .002)	3.00 (1.30–6.68, P = .008)
Multiple aneurysms	2.52 (1.23–4.98, P = .009)	2.55 (1.16–5.42, P = .017)
Aneurysm location
Basilar artery	Ref	Ref
Posterior cerebral artery	1.00 (0.33–2.66, P = .997)	1.20 (0.38–3.42, P = .747)
Posterior inferior cerebellar artery	0.40 (0.06–1.54, P = .244)	0.52 (0.08–2.17, P = .421)
Superior cerebellar artery	0.69 (0.04–4.24, P = .735)	0.75 (0.04–5.50, P = .806)
Vertebral artery	0.45 (0.21–0.94, P = .032)	0.41 (0.18–0.90, P = .025)
Vertebrobasilar junction	2.25 (0.76–6.25, P = .126)	1.56 (0.46–5.03, P = .461)
Aneurysm shape
Fusiform/dolichoectatic/dissecting	Ref	Ref
Saccular	0.40 (0.18–0.81, P = .017)	0.43 (0.18–0.95, P = .045)
Size of aneurysm (mm)	1.04 (1.00–1.07, P = .021)	1.01 (0.97–1.05, P = .612)
Previous SAH
None	Ref
<2 weeks	1.50 (0.61–3.33, P = .348)
>2 weeks	0.69 (0.11–2.51, P = .633)
Prior treatment
None	Ref
Endovascular	0.71 (0.16–2.11, P = .585)
Operation	6.62 (0.26–169.46, P = .184)
Both	NA
Number of devices
1	Ref	Ref
≥2	3.51 (1.84–6.64, P < .001)	1.79 (0.82–3.82, P = .136)
Antiplatelet regimen changed	0.72 (0.04–4.00, P = .759)
Adjunctive coiling	0.76 (0.30–1.68, P = .531)

Note:—NA indicates not applicable; Ref, reference variable for comparison.
↵a Covariates that have P < .1 in the univariable analysis were included in the multivariable analysis. Data are OR (95% CI, P Value).