Treatment of Distal Anterior Circulation Aneurysms With the Pipeline Embolization Device: A US Multicenter Experience.

Abstract

BACKGROUND:

Utilization of the Pipeline embolization device (PED) to treat distal carotid circulation aneurysms has not been well studied.

OBJECTIVE:

To report the collective experience of using PED to treat distal anterior circulation aneurysms.

METHODS:

We retrospectively reviewed clinical and radiographic records of all patients who underwent Pipeline embolization of distal anterior circulation aneurysms at 10 US neurosurgical centers between 2011 and 2013.

RESULTS:

Twenty-eight patients (mean age 51.7 years; 18 women) with 28 aneurysms were included in the analyses. Fifteen aneurysms were fusiform, 5 dissecting, and 8 saccular. Average aneurysm size was 12.3 mm; 7 were giant. Twenty aneurysms were located along the middle cerebral artery, 6 along the anterior cerebral artery, and 2 along the anterior communicating artery. PED deployment was successful in 27 patients, with coils utilized in 6 cases. Clinical follow-up was available for an average of 10.7 months (range 3-26). Twenty-seven patients had follow-up neurovascular imaging: 21 aneurysms had complete occlusion, 4 had residual neck filling, and 2 had residual dome filling. Periprocedural complications (<30 days) occurred in 3 patients (10.7%), including 1 case of device failure resulting in stroke. Outcomes were good (modified Rankin Scale score 0 to 2) in 27 patients (96.4%) and fair (modified Rankin Scale 3) in 1.

CONCLUSION:

PED can be utilized in the treatment of distal anterior circulation aneurysms with difficult anatomy for conventional surgical or endovascular techniques. Larger-scale studies with long-term follow-up are needed to further elucidate the durability of PED treatment and its effect on perforator-rich vascular segments.

ABBREVIATIONS:

ACA, anterior cerebral arteryAcomA, anterior communicating arteryDSA, digital subtraction angiographyMCA, middle cerebral arterymRS, modified Rankin scalePED, Pipeline embolization device.

• Authors: Ning Lin, Giuseppe Lanzino, Demetrius K Lopes, Adam S Arthur, Christopher S Ogilvy, Robert D Ecker, Travis M Dumont, Raymond D Turner 4th, M Reid Gooch, Alan S Boulos, Peter Kan, Kenneth V Snyder, Elad I Levy, Adnan H Siddiqui
• Journal: Neurosurgery (Neurosurgery) Vol. 79 Issue 1 Pg. 14-22 (Jul 2016) ISSN: 1524-4040 [Electronic] United States
• PMID: 26579967 (Publication Type: Journal Article, Multicenter Study)

Topics

• Aged
• Anterior Cerebral Artery (pathology)
• Embolization, Therapeutic (adverse effects, methods)
• Endovascular Procedures (adverse effects, methods)
• Equipment Failure
• Female
• Follow-Up Studies
• Humans
• Intracranial Aneurysm (surgery)
• Male
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• United States