Treatment of complex anterior cerebral artery aneurysms with Pipeline flow diversion: mid-term results

J Neurointerv Surg. 2017 Feb;9(2):147-151. doi: 10.1136/neurintsurg-2016-012519. Epub 2016 Jul 5.

Abstract

Background: The off-label use of flow diverters in the treatment of distal aneurysms continues to be debated.

Objective: To report our multicenter experience in the treatment of complex anterior cerebral artery aneurysms with the Pipeline embolization device (PED).

Methods: The neurointerventional databases of the four participating institutions were retrospectively reviewed for aneurysms treated with PED between October 2011 and January of 2016. All patients treated for anterior cerebral artery aneurysms were included in the analysis. Clinical presentation, location, type, vessel size, procedural complications, clinical and imaging follow-up were included in the analysis.

Results: Twenty patients (13 female) with 20 aneurysms met the inclusion criteria in our study. Fifteen aneurysms were classified as saccular and five as fusiform (mean size 7.3 mm). Thirteen aneurysms were located in the anterior communicating region (ACOM or A1/2 junction), six were A2-pericallosal, and one was located in the A1 segment. Six patients had presented previously with subarachnoid hemorrhage and had their aneurysms initially clipped or coiled. There was one minor event (a small caudate infarct) and one major event (intraparenchymal hemorrhage). Sixteen of the 20 patients had angiographic follow-up (mean 10 months). Eleven aneurysms were completely occluded, one had residual neck, and four had residual aneurysm filling.

Conclusions: The treatment of complex anterior cerebral artery aneurysms with the PED as an alternative for patients who are not good candidates for conventional methods is technically feasible and safe. Mid-term results are promising but larger series with long-term follow-up are required to assess its effectiveness.

Keywords: Aneurysm; Angiography; Flow Diverter; Intervention.

Publication types

  • Multicenter Study
  • Review

MeSH terms

  • Adult
  • Aged
  • Anterior Cerebral Artery / diagnostic imaging
  • Anterior Cerebral Artery / surgery
  • Blood Vessel Prosthesis Implantation
  • Blood Vessel Prosthesis*
  • Cerebral Angiography
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / surgery*
  • Cerebral Infarction / etiology
  • Cerebral Infarction / surgery
  • Female
  • Humans
  • Infarction, Anterior Cerebral Artery / diagnostic imaging
  • Infarction, Anterior Cerebral Artery / surgery*
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / surgery*
  • Magnetic Resonance Angiography
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods
  • Retrospective Studies