Related Experiment Video
Updated: Apr 7, 2026
Optimization of the Longa Middle Cerebral Artery Occlusion Method for Complete Reperfusion
Published on: November 22, 2024
Low frequency of delayed ischemic events on MRI after flow diversion for intracranial aneurysms
Saul F Morales-Valero1, Waleed Brinjikji2, John T Wald3
1Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Background:
The rate of silent ischemia detected on Magnetic Resonance Imaging (MRI) in the long-term follow-up period following endovascular treatment of intracranial aneurysms with the Pipeline Embolization Device (PED) is not well established. The purpose of this study was to evaluate the occurrence rate of silent ischemia detected on MRI in patients undergoing treatment of intracranial aneurysms with PED receiving at least 6 months of MRI follow-up.
Methods:
We evaluated our institution's database of patients receiving PED treatment of intracranial aneurysms. Imaging records were searched to identify which patients received an MRI at least six-months postoperatively. MR images were reviewed for evidence of new infarction and medical records were reviewed to determine the clinical outcome.
Results:
Of the 68 patients with MR imaging following aneurysm treatment with PED, 40 patients had an MRI at least six months following treatment with the PED. Of patients with MRI at ≥6 months following PED treatment, 2/40 (5.0%) had a new infarct. Of these, one had a lacunar infarct which was likely non-embolic and one patient had a punctate infarction in the contralateral centrum semiovale. None of these infarcts were symptomatic.
Conclusions:
In this study, a small number of silent ischemic events (5.0%) was found on routine long-term follow-up MRI of patients undergoing flow diversion. These events did not lead to any neurologic deficits. Our findings add to the available evidence on the long-term safety of flow diversion for the treatment of intracranial aneurysms.
Insights
Silent ischemia after Pipeline Embolization Device (PED) treatment for intracranial aneurysms is uncommon, with only 5% of patients showing new infarcts on long-term MRI follow-up. These silent ischemic events did not cause neurological deficits, indicating the safety of flow diversion.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Medical Imaging
Background:
- Long-term silent ischemia rates after Pipeline Embolization Device (PED) for intracranial aneurysms are not well-established.
- Evaluating silent ischemic events on Magnetic Resonance Imaging (MRI) is crucial for assessing treatment safety.
- Flow diversion is an endovascular technique for treating intracranial aneurysms.
Purpose of the Study:
- To determine the occurrence rate of silent ischemia detected by MRI in patients treated with PED.
- To assess patients receiving at least six months of MRI follow-up post-PED treatment.
Main Methods:
- Retrospective review of institutional database for patients treated with PED.
- Identification of patients with MRI at least six months postoperatively.
- Review of MR images for new infarcts and clinical outcomes.
Main Results:
- 40 patients had MRI at least six months post-PED treatment.
- 2 out of 40 patients (5.0%) showed new infarcts on follow-up MRI.
- Infarcts were small, asymptomatic, and one was likely non-embolic.
Conclusions:
- A low rate of silent ischemic events (5.0%) was observed on long-term follow-up MRI after flow diversion.
- These asymptomatic events did not result in neurological deficits.
- Findings support the long-term safety of flow diversion for intracranial aneurysm treatment.
