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

Background and Purpose: 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. Materials and Methods: We performed a retrospective analysis of a prospectively maintained database from five 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. Results: 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 modified Rankin Scale (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 post-operatively, 53.8% (n = 35) at 12–18 months post-operatively, 84.0% (n = 42) at 19–48 months post-operatively, and 86.5% (n = 45) at > 48 months post-operatively. 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. Conclusions: 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 to 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 neurological deficit.