Flow diversion treatment of complex bifurcation XXXX beyond the circle of Willis: a single-center series with special emphasis on covered cortical branches and perforating arteries.

@entity1 @entity8987 @entity439 @entity63
BACKGROUND: Data regarding anatomic and clinical results of flow diversion treatment in complex bifurcation @entity439 of the anterior circulation are scarce. OBJECTIVE: To present our results of treatment of these lesions with special emphasis on the fate of 'jailed' cortical branches and perforating arteries. METHODS: Seventeen @entity1 were treated with flow diverters (FDs) for 18 @entity439 of the middle cerebral artery bifurcation (n=13) and the anterior communicating artery complex (n=5). Nineteen cortical branches were covered. A single FD was used in all @entity1 . RESULTS: At latest follow-up (mean 7.9 months; range 3-36; median 4.0) 2/19 (10.5%) of the covered branches were occluded, 9/19 (47.4%) showed a decreased caliber and the remaining branches were unchanged. All branch modifications were clinically asymptomatic. Mortality and permanent morbidity were 0%. Symptomatic @entity63 events in perforator territories occurred in three @entity1 (17.6%), which were reversible in all of them within 24   h. Follow-up MRI disclosed asymptomatic @entity8987 corresponding to covered perforating artery territories in five @entity1 (29.4%). Altogether, perforator lesions-symptomatic and asymptomatic-occurred in 7/17 @entity1 (41.2%). 33.3% of the @entity439 were occluded at latest follow-up; decreased diameters were seen in the other 66.7%. CONCLUSIONS: Flow diversion of bifurcation @entity439 is feasible with low rates of permanent morbidity and mortality. Caliber reduction and asymptomatic occlusion of covered cortical branches seems to be common, yet @entity63 complications are rather linked to perforator occlusions. Our results on @entity439 rates are preliminary and longer follow-up periods are warranted.
