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Treatment of Distal Anterior Circulation Aneurysms With the Pipeline Embolization Device: A US Multicenter Experience
Ning Lin1, Giuseppe Lanzino, Demetrius K Lopes
1*Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ‡Current affiliation: Department of Neurosurgery, Weill Cornell Medical College, New York City, New York; §Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; ¶Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois; ‖Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee; #Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; **Neuroscience Institute, Maine Medical Center, Portland, Maine; ‡‡Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona; §§Division of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina; ¶¶Department of Neurosurgery, Albany Medical Center, Albany, New York; ‖‖Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; ##Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ***Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ‡‡‡Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; §§§Jacobs Institute, Buffalo, New York.
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.
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