Aneurysms with persistent filling after failed treatment with the Pipeline embolization device

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• The Pipeline embolization device (PED) is a key tool for treating cerebral aneurysms.
• Treatment failures with PED have been documented, but the specific characteristics and outcomes of these cases require further investigation.

Purpose of the Study:

• To identify patient and aneurysm characteristics associated with residual filling after PED treatment for cerebral aneurysms.
• To analyze factors contributing to incomplete aneurysm occlusion following PED placement.

Main Methods:

• Retrospective review of electronic medical records and imaging studies for patients treated with PED between July 2010 and March 2015.
• Identification and analysis of 52 aneurysms with residual filling among 281 patients with long-term follow-up.

Main Results:

• 16.4% of treated aneurysms showed residual filling. Significant factors associated with incomplete occlusion included patient age over 65, prior stent placement, distal anterior circulation location (MCA, PCoA, ACA), and longer follow-up duration.
• Specific aneurysm types like carotid ophthalmic and middle cerebral artery aneurysms had notable rates of residual filling.

Conclusions:

• While the PED is effective for complex aneurysms, treatment failures occur in 16.4% of cases.
• Aneurysm characteristics such as size, shape, and prior treatments, alongside patient factors like age, influence treatment outcomes and the likelihood of incomplete occlusion.