Aneurysms with persistent patency after treatment with the Pipeline Embolization Device

Area of Science:

• Neurosurgery
• Interventional Radiology
• Vascular Neurology

Background:

• The Pipeline Embolization Device (PED) is approved for specific internal carotid artery aneurysms.
• Off-label use of PED has expanded to other locations and aneurysm types.
• Cerebral aneurysms in end vessels lacking distal collaterals present unique treatment challenges.

Purpose of the Study:

• To evaluate the efficacy of the Pipeline Embolization Device (PED) in treating cerebral aneurysms located in end vessels with no significant distal collaterals.
• To assess the occlusion rates and clinical outcomes of PED treatment in this challenging subset of intracranial aneurysms.

Main Methods:

• Retrospective analysis of 15 patients with 16 cerebral aneurysms treated with PED.
• Aneurysms included posterior communicating artery, ophthalmic artery, superior cerebellar artery, anterior inferior cerebellar artery, and middle cerebral artery locations.
• Follow-up evaluation averaged 24 months to assess aneurysm occlusion.

Main Results:

• None of the treated aneurysms achieved significant occlusion at the final follow-up.
• The study cohort included diverse locations, with a notable number of posterior communicating and ophthalmic artery aneurysms.
• The Pipeline Embolization Device demonstrated limited success in occluding these specific types of cerebral aneurysms.

Conclusions:

• Flow diverters, including the Pipeline Embolization Device (PED), are not recommended for treating cerebral aneurysms in end vessels lacking significant distal collaterals.
• The observed lack of significant occlusion suggests limitations of current flow-diverting technology for this aneurysm subset.
• Further research may be needed to explore alternative or modified treatment strategies for these complex intracranial aneurysms.