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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. 1Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3Microvention Inc, Aliso Viejo, USA
  1. Correspondence to Dr Jonathan A Grossberg, Department of Neurosurgery, Emory University, Atlanta GA 30303, USA; jonathan.a.grossberg{at}emory.edu

Abstract

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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Footnotes

  • 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.

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