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O-021 Pipeline embolization of posterior circulation aneurysms: a multicenter study of 131 aneurysms
  1. Christoph J Griessenauer1,
  2. Christopher S Ogilvy1,
  3. Nimer Adeeb1,
  4. Adam A Dmytriw1,2,3,
  5. Paul M Foreman4,
  6. Hussain Shallwani5,
  7. Nicola Limbucci6,
  8. Salvatore Mangiafico6,
  9. Ashish Kumar2,
  10. Caterina Michelozzi7,
  11. Timo Krings3,
  12. Vitor Mendes Pereira3,
  13. Charles C Matouk8,
  14. Mark R Harrigan4,
  15. Hakeem J Shakir5,
  16. Adnan H Siddiqui5,
  17. Elad I Levy5,
  18. Leonardo Renieri6,
  19. Thomas R Marotta2,
  20. Christophe Cognard7,
  21. Ajith J Thomas1
  1. 1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
  2. 2Division of Diagnostic and Therapeutic Neuroradiology, St. Michael’s Hospital, Toronto, Ontario, Canada
  3. 3Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
  4. 4Department of Neurosurgery, University of Alabama at Birmingham, AL
  5. 5Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY
  6. 6Department of Interventional Neuroradiology, University of Florence, Italy
  7. 7Department of Diagnostic and Therapeutic Neuroradiology, Toulouse University Hospital, Toulouse, France
  8. 8Department of Neurosurgery, Yale School of Medicine, New Haven, CT

Abstract

Introduction Flow diversion for posterior circulation aneurysms using the Pipeline Embolization Device (PED) constitutes an increasingly common off-label use for otherwise untreatable aneurysms. Safety and efficacy of this treatment modality has not been assessed in a multicenter study.

Methods A retrospective review of prospectively maintained databases at eight academic institutions was performed from the years 2009 to 2016 to identify patients with posterior circulation aneurysms treated with PED placement.

Results One-hundred and twenty-nine consecutive patients underwent 129 procedures to treat 131 aneurysms. Twenty-nine dissecting, 53 fusiform, and 49 saccular were included. At a median follow-up of 11 months, complete and near complete occlusion was recorded in 78.1%. Dissecting aneurysms had the highest occlusion rate and fusiform the lowest. Major complications were most frequent in fusiform aneurysms. Minor complications occurred most commonly in saccular aneurysms. In patients with saccular aneurysms, clopidogrel responders had a lower complication rate than clopidogrel non-responders. The majority of dissecting aneurysms were treated in the acute phase following subarachnoid hemorrhage and were associated with the highest mortality rate; however, the rate of other major or minor complications was the lowest among the three aneurysm morphologies. The difference between complications in the ruptured and unruptured group was not statistically significant.

Conclusion In the largest series to date, fusiform aneurysms were found to have the lowest occlusion rate and highest frequency of major complications. Dissecting aneurysms, frequently treated in the setting of subarachnoid hemorrhage, occluded most often and had the lowest complication rate. Saccular aneurysms were associated with predominantly minor complications, particularly in clopidogrel non-responders.

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