Pipeline embolization device treatment of internal carotid artery terminus aneurysms. (24th November 2018)

• Record Type: Journal Article
• Authors: Pujari, Amit; Howard, Brian Matthew; Madaelil, Thomas P; Skukalek, Susana Libhaber; Roy, Anil K; Dion, Jacques E; Cawley, C Michael; Grossberg, Jonathan A
• Is Part Of: Journal of neurointerventional surgery. Volume 11:Number 5(2019)
• Page Start: 485
• Page End: 488
• Publication Date: 2018-11-24
• Subjects: pipeline -- internal carotid artery terminus aneurysm; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2018-014312
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: The pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied. Methods: We conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded. Results: Mean age was 46.9 years (± 8.8), and 6 (60%) patients were women. The mean maximum diameter of the aneurysms treated was 14.7 mm (± 10.7) and the mean neck diameter was 9.3 mm (± 6.6). Reasons for presentation included six incidental findings, one acute subarachnoid hemorrhage (SAH), and three patients with prior SAH. Kamran–Byrne Occlusion Scale scores for the treated aneurysms were as follows: three class IV (complete obliteration), four class III (<50% filling in both height and width for fusiform aneurysms or residual neck for saccular aneurysms), one class II fusiform aneurysm, 1 class 0 saccular aneurysm (residual aneurysm body), and one not classified due to pipeline thrombosis. Two clinically asymptomatic complications were noted: one patient who had a small distal cortical SAH post PED and one patient whose stent was found to be thrombosed on follow-up angiogram. All patients were seen in follow-up, and no patients were found to have worsening of their pre-procedure modified Rankin Scale score. Conclusion: The PED has potential for treating ICA-T aneurysms not amenable to conventional treatment strategies. Further studies are warranted to confirm the long term outcomes.