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Hemorrhagic stroke
Case series
Treatment of complex anterior cerebral artery aneurysms with Pipeline flow diversion: mid-term results
Free
  1. Guilherme Dabus1,2,3,
  2. Jonathan A Grossberg4,
  3. C Michael Cawley4,
  4. Jacques E Dion4,
  5. Ajit S Puri5,
  6. Ajay K Wakhloo5,
  7. Douglas Gonsales6,
  8. Pedro Aguilar-Salinas6,
  9. Eric Sauvageau6,
  10. Italo Linfante1,2,3,
  11. Ricardo A Hanel6
  1. 1Miami Cardiac & Vascular Institute, Florida International University, Miami, Florida, USA
  2. 2Baptist Neuroscience Center, Florida International University, Miami, Florida, USA
  3. 3Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
  4. 4Departments of Radiology and Neurosurgery, Emory University, Atlanta, Georgia, USA
  5. 5Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
  6. 6Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida, USA
  1. Correspondence to Dr Guilherme Dabus, Miami Cardiac & Vascular Institute, 8900 N Kendall Drive, Miami, FL 33176, USA; gdabus{at}gmail.com

Abstract

Background The off-label use of flow diverters in the treatment of distal aneurysms continues to be debated.

Objective To report our multicenter experience in the treatment of complex anterior cerebral artery aneurysms with the Pipeline embolization device (PED).

Methods The neurointerventional databases of the four participating institutions were retrospectively reviewed for aneurysms treated with PED between October 2011 and January of 2016. All patients treated for anterior cerebral artery aneurysms were included in the analysis. Clinical presentation, location, type, vessel size, procedural complications, clinical and imaging follow-up were included in the analysis.

Results Twenty patients (13 female) with 20 aneurysms met the inclusion criteria in our study. Fifteen aneurysms were classified as saccular and five as fusiform (mean size 7.3 mm). Thirteen aneurysms were located in the anterior communicating region (ACOM or A1/2 junction), six were A2-pericallosal, and one was located in the A1 segment. Six patients had presented previously with subarachnoid hemorrhage and had their aneurysms initially clipped or coiled. There was one minor event (a small caudate infarct) and one major event (intraparenchymal hemorrhage). Sixteen of the 20 patients had angiographic follow-up (mean 10 months). Eleven aneurysms were completely occluded, one had residual neck, and four had residual aneurysm filling.

Conclusions The treatment of complex anterior cerebral artery aneurysms with the PED as an alternative for patients who are not good candidates for conventional methods is technically feasible and safe. Mid-term results are promising but larger series with long-term follow-up are required to assess its effectiveness.

  • Aneurysm
  • Angiography
  • Flow Diverter
  • Intervention

https://doi.org/10.1136/neurintsurg-2016-012519

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    Footnotes

    • Contributors Conception: GD, JAG, ASP, and RAH; acquisition and interpretation of the data: GD, IL, JAG, CMC, JED, ASP, AKW, DG, PA-S, ES, and RAH; drafting: GD; revising: GD, IL, JAG, ASP, and RAH; final approval: GD, IL, JAG, CMC, JED, ASP, AKW, DG, PA-S, ES, and RAH.

    • Competing interests GD, IL, ASP, and RAH are consultants and proctors for Medtronic Neurovascular.

    • Ethics approval Institutional review boards.

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