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Original research
Pipeline embolization device treatment of internal carotid artery terminus aneurysms
  1. Amit Pujari1,
  2. Brian Matthew Howard2,
  3. Thomas P Madaelil2,
  4. Susana Libhaber Skukalek2,
  5. Anil K Roy2,
  6. Jacques E Dion3,
  7. C Michael Cawley2,
  8. Jonathan A Grossberg2
  1. 1 Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2 Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3 Microvention Inc, Aliso Viejo, USA
  1. Correspondence to Dr Jonathan A Grossberg, Department of Neurosurgery, Emory University, Atlanta GA 30303, USA; jonathan.a.grossberg{at}


Background The pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied.

Methods We conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded.

Results Mean age was 46.9 years (± 8.8), and 6 (60%) patients were women. The mean maximum diameter of the aneurysms treated was 14.7 mm (± 10.7) and the mean neck diameter was 9.3 mm (± 6.6). Reasons for presentation included six incidental findings, one acute subarachnoid hemorrhage (SAH), and three patients with prior SAH. Kamran–Byrne Occlusion Scale scores for the treated aneurysms were as follows: three class IV (complete obliteration), four class III (<50% filling in both height and width for fusiform aneurysms or residual neck for saccular aneurysms), one class II fusiform aneurysm, 1 class 0 saccular aneurysm (residual aneurysm body), and one not classified due to pipeline thrombosis. Two clinically asymptomatic complications were noted: one patient who had a small distal cortical SAH post PED and one patient whose stent was found to be thrombosed on follow-up angiogram. All patients were seen in follow-up, and no patients were found to have worsening of their pre-procedure modified Rankin Scale score.

Conclusion The PED has potential for treating ICA-T aneurysms not amenable to conventional treatment strategies. Further studies are warranted to confirm the long term outcomes.

  • pipeline
  • internal carotid artery terminus aneurysm

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  • AP and BMH contributed equally.

  • Contributors Conception and design: AP, BMH, and JAG. Acquisition of the data: AP, BMH, SLS, TPM, and JAG. Analysis and interpretation of the data: AP, BMH, and JAG. Drafting of the article: AP, BMH, and JAG. Critical revision: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Emory University institutional review board.

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

  • Data sharing statement Any data analyzed for this study are available upon request from the corresponding author.