RT Journal Article SR Electronic T1 A2, M2, P2 aneurysms and beyond: results of treatment with pipeline embolization device in 65 patients JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP 903 OP 907 DO 10.1136/neurintsurg-2018-014631 VO 11 IS 9 A1 Christopher T Primiani A1 Zeguang Ren A1 Peter Kan A1 Ricardo Hanel A1 Vitor Mendes Pereira A1 Wai Man Lui A1 Nitin Goyal A1 Lucas Elijovich A1 Adam S Arthur A1 David M Hasan A1 Santiago Ortega-Gutierrez A1 Edgar A Samaniego A1 Ajit S Puri A1 Anna L Kuhn A1 Kirill Orlov A1 Dmitry Kislitsin A1 Anton Gorbatykh A1 Muhammad Waqas A1 Elad I Levy A1 Adnan H Siddiqui A1 Maxim Mokin YR 2019 UL http://jnis.bmj.com/content/11/9/903.abstract AB Background Intracranial aneurysms located in the distal vessels are rare and remain a challenge to treat through surgical or endovascular interventions.Objective To describe a multicenter approach with flow diversion using the pipeline embolization device (PED) for treatment of distal intracranial aneurysms.Methods Cases of distal intracranial aneurysms defined as starting on or beyond the A2 anterior cerebral artery, M2 middle cerebral artery, and P2 posterior cerebral artery segments were included in the final analysis.Results 65 patients with distal aneurysms treated with the PED were analyzed. Median aneurysm size at the largest diameter was 7.0 mm, 60% were of a saccular morphology, and 9/65 (13.8%) patients presented in the setting of acute rupture. Angiographic follow-up data were available for 53 patients, with a median follow-up time of 6 months: 44/53 (83%) aneurysms showed complete obliteration, 7/53 (13.2%) showed reduced filling, and 2/53 (3%) showed persistent filling. There was no association between patient characteristics, including aneurysm size (P=0.36), parent vessel diameter (P=0.27), location (P=0.81), morphology (P=0.63), ruptured status on admission (P=0.57), or evidence of angiographic occlusion at the end of the embolization procedure (P=0.49). Clinical outcome data were available for 60/65 patients: 95% (57/60) had good clinical outcome (modified Rankin Scale score of 0–2) at 3 months.Conclusions This large multicenter study of patients with A2, M2, and P2 distal aneurysms treated with the PED showed that flow diversion may be an effective treatment approach for this rare type of vascular pathology. The procedural compilation rate of 7.7% indicates the need for further studies as the flow diversion technology constantly evolves.