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  • Endovascular flow diversion for treatment of anterior communicating artery region cerebral aneurysms: a single-center cohort of 50 cases

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Hemorrhagic stroke
Case series
Endovascular flow diversion for treatment of anterior communicating artery region cerebral aneurysms: a single-center cohort of 50 cases
  1. Geoffrey P Colby1,
  2. Matthew T Bender1,
  3. Li-Mei Lin2,
  4. Narlin Beaty1,
  5. Judy Huang1,
  6. Rafael J Tamargo1,
  7. Alexander L Coon1
  1. 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Neurosurgery, University of California Irvine, Orange, California, USA
  1. Correspondence to Dr Alexander Coon, Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, 1800 Orleans St, Zayed 6115E, Baltimore, MD 21287, USA; acoon2{at}jhmi.edu

Abstract

Background Flow diversion represents a novel but definitive treatment for recurrent and difficult-to-coil aneurysms of the anterior communicating artery (ACoA) region, of which reports are limited.

Objective To determine the effectiveness of the Pipeline embolization device (PED) in treating aneurysms in the ACoA region.

Methods We retrospectively reviewed an IRB-approved database of patients with an aneurysm at a single institution for patients with ACoA or A1–A2 aneurysms treated with PED. Data analyzed included demographics, aneurysm characteristics, procedural details, follow-up results, and outcomes.

Results A total of 50 procedures were performed on 41 patients, including seven patients who underwent bilateral ‘H-pipe’ PED placement. The average age was 56 years and 46% of the patients were female. The average aneurysm size was 4.5 mm, and two large (>10 mm) aneurysms were treated. The vessel of origin was either the ACoA (26 aneurysms, 63%) or the A1–A2 junction (15 aneurysms, 37%). Eighteen patients (44%) had prior subarachnoid hemorrhage and 20 had previously been treated either with clipping (6 aneurysms, 15%) or coiling (14 aneurysms, 34%). Procedural success was achieved in 48/50 cases (96%) and two cases were aborted. Coils were deployed adjunctively in two cases (4%). Procedural outcomes included no deaths, one major ischemic stroke (2%), and two patients with intracranial hemorrhage (4%). Complete aneurysm occlusion was achieved in 81% of patients at 6 months and 85% of patients at last follow-up digital subtraction angiography.

Conclusions The PED can be used safely and effectively in the treatment of aneurysms of the ACoA region. This represents a good alternative treatment option to microsurgical clipping and endovascular coiling.

  • Flow Diverter
  • Aneurysm
  • Technique

https://doi.org/10.1136/neurintsurg-2016-012946

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    Footnotes

    • GPC and MTB are joint first authors.

    • Contributors All authors contributed significantly to conception, data acquisition, and analysis; all drafted and revised manuscript contents; and all approved the final version of the manuscript. GPC and MTB contributed equally to this paper.

    • Competing interests AC is a consultant and proctor for Medtronic, Styker, and Microvention. GPC is a consultant for Medtronic and Microvention.

    • Ethics approval Ethics approval was obtained from the Johns Hopkins University Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The relevant anonymised patient level data are available on reasonable request from the authors.