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Original research
The value of long-term angiographic follow-up following Pipeline embolization of intracranial aneurysms
  1. David C Lauzier1,
  2. Samuel J Cler1,
  3. Arindam R Chatterjee1,2,3,
  4. Joshua W Osbun1,2,3,
  5. Christopher J Moran1,2,
  6. Akash P Kansagra1,2,3
  1. 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
  2. 2Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
  3. 3Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
  1. Correspondence to Dr Akash P Kansagra, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA; apkansagra{at}gmail.com

Abstract

Background Flow diversion of intracranial aneurysms with the Pipeline Embolization Device (PED) is commonly performed, but the value of long-term angiographic follow-up has not been rigorously evaluated. Here we examine the prevalence of actionable findings of aneurysm recurrence and development of in-stent stenosis in a cohort of patients that underwent long-term angiographic follow-up at multiple time points.

Methods Angiographic data from eligible patients were retrospectively assessed for aneurysm occlusion, in-stent stenosis, and aneurysm regrowth or recurrence. Patients were included in this study if they underwent angiographic imaging at 6 months post-treatment and at least one later time point.

Results 100% (132/132) of aneurysms occluded at 6 months remained occluded at final follow-up. 85.7% (6/7), 56.3% (27/48), and 25% (6/24) of aneurysms with entry remnant, subtotal filling, and total filling, respectively, at 6 months were completely occluded at final follow-up. 98.7% (147/149) of PED constructs that demonstrated no stenosis at 6 months demonstrated no stenosis at final angiography, while 44.4% (8/18) of PED constructs demonstrating in-stent stenosis at 6 months had resolution of stenosis on final angiography.

Conclusions Among patients who undergo treatment of intracranial aneurysms with PED, the value of long-term angiography in patients demonstrating complete aneurysm occlusion and no in-stent stenosis on 6 month post-treatment angiography is low.

  • aneurysm
  • flow diverter

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors All authors have met ICMJE criteria for authorship, and all authors have read and approved the submitted manuscript. Study conception: DCL and APK. Data collection: DCL, SJC. Data analysis: DCL, SJC, and APK. Manuscript writing: DCL and APK. Critical revision: SJC, APK, ARC, JWO, CJM, APK. Final approval: SJC, APK, ARC, JWO, CJM, APK.

  • 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 JWO is a consultant for Medtronic and Microvention. CJM is a consultant for Medtronic and Cerenovus. APK is a consultant for Penumbra, Microvention, and iSchemaView, and is on the iSchemaView medical advisory board.

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

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