Medical Student Washington University School of Medicine St. Louis, Missouri, United States
Introduction: Flow diversion of intracranial aneurysms with the pipeline embolization device has become a common treatment strategy for intracranial aneurysms in the past decade. One practical application of the pipeline embolization device is for the treatment of complex fusiform aneurysms given the volatility of these aneurysms if left untreated and the lack of other suitable treatment options. Here, we report our institutional experience using the pipeline embolization device for fusiform aneurysms.
Methods: Clinical and angiographic data were retrospectively obtained from the electronic medical record and aggregated in a dedicated neurointerventional database. Eligible patients were assessed for key clinical and angiographic outcomes. Degree of angiographic filling of aneurysms is reported using the O'Kelley-Marrotta grading scale.
Results: 33 fusiform aneurysms in 32 patients were treated with the pipeline embolization device during the study period. Median age at treatment was 58.4 years (IQR 49.0-66.5) and 65.6% of patients were female (21/32). One patient had two fusiform aneurysms treated with the pipeline embolization device and one patient had a single aneurysm that underwent two separate pipeline treatments. Treated aneurysms were located in the following locations: 21.2% (7/33) vertebral artery, 12.1% (4/33) basilar artery, 33.3% (11/33) ICA, 15.1% (5/3) PICA, 15.1% (5/33) MCA, 3.3% (1/33) PCA. Angiographic follow-up was available for 93.9% (31/33) of aneurysms treated. At final angiographic follow-up, 74.1% (23/31) of aneurysms were completely occluded, 3.2% (1/31) of aneurysms only included an entry remnant, 16.1% (5/31) of aneurysms demonstrated subtotal filling, and 6.5% (2/31) of aneurysms demonstrated total filling. Ischemic complications were experienced by 12.5% (4/32) of patients and hemorrhagic complications were experienced by 3.1% (1/32) of patients.
Conclusion : Pipeline embolization of fusiform cerebral aneurysms demonstrated a 74.1% rate of complete aneurysm occlusion at final follow-up. However, caution is necessary when treating these aneurysms given the risk for ischemic and hemorrhagic events.
