Impact of Catheter-Induced Flow Compromise on the Presence of Multiple Ischemic Lesions in Endovascular Treatment of Posterior Circulation Aneurysms: A Two-Center Retrospective Study.
Abstract
Purpose
Catheter-induced flow compromise (CFC) occurs during endovascular treatment of posterior circulation aneurysms; however, its embolic risk-particularly that of incomplete flow stasis as distinct from complete wedge-remains poorly characterized. We aimed to define CFC angiographically and evaluate its association, including subtype-specific effects, with multiple new ischemic lesions (MNIL) on postoperative diffusion-weighted imaging (DWI).
Methods
We retrospectively reviewed 108 patients treated for posterior circulation aneurysms at two institutions. CFC was defined angiographically as either flow stasis or wedge and was assessed independently by two blinded readers. Predictors of the primary outcome-multiple (≥ 3) new ischemic lesions on postoperative DWI-were identified by multivariable logistic regression adjusted for age, rupture status, and use of a double-catheter system.
Results
CFC occurred in 56.5% of patients and MNIL in 33.3%. Aneurysm rupture and CFC were independent predictors of MNIL (CFC: adjusted OR, 3.30; 95% CI, 1.18-9.23; p = 0.023), and both subtypes remained significant. The association was of similar magnitude when the eight patients managed with intraprocedural contralateral angiography were excluded (adjusted OR, 3.36; 95% CI, 1.20-9.44). Tortuosity at the vertebral artery origin was the principal predictor of CFC, and inter-rater agreement for CFC was almost perfect.
Conclusion
CFC was independently associated with MNIL in posterior circulation aneurysm embolization and occurred more frequently in patients with tortuosity at the vertebral artery origin, supporting preoperative assessment of vessel anatomy. Incomplete flow stasis carried a substantial embolic risk, warranting the same vigilance as wedge. Determining whether intraprocedural risk-avoidance strategies reduce the ischemic burden requires prospective evaluation.