Neurointervention.  2018 Mar;13(1):32-40. 10.5469/neuroint.2018.13.1.32.

Treatment of Intracranial Aneurysms with the Pipeline Embolization Device Only: a Single Center Experience

• Volker M
• Anastasios M
• Jan B
• Nuran A
• Thomas L
• Franziska
• Pantelis S
• De-Hua C
• Christoph

• KMID: 2424047
• DOI: http://doi.org/10.5469/neuroint.2018.13.1.32

Abstract

PURPOSE
The aim of this study was to evaluate the technical feasibility and rate of mid-term occlusion in aneurysms treated solely with the Pipeline Embolization Device (PED) in a German tertiary care university hospital.
MATERIALS AND METHODS
Forty-nine non-consecutive intracranial aneurysms underwent endovascular treatment using the PED exclusively between March 2011 and May 2017 at our institution. Primary endpoint was a favorable aneurysm occlusion defined as OKM C1-3 and D (O'Kelly Marotta Scale). Secondary endpoints were retreatment rate and delayed complications. Median follow-up was 200 days.
RESULTS
The mean aneurysm size was 7.1 ± 5.3 mm. Forty-four aneurysms were located in the anterior circulation (90%). Ten aneurysms were ruptured (20%). Branching vessels from the sac were observed in 11 aneurysms (22%). Favorable obliteration immediately after PED placement was seen in 13/49 aneurysms (27%), of those nine aneurysms were completely occluded (18%). Angiographic and clinical follow-up was available for 45 cases (92%); 36/45 aneurysms (80%) were occluded completely and 40/45 aneurysms (89%) showed a favorable occlusion result. A branching vessel arising from the aneurysm sac was associated with incomplete occlusion (P < .05). All electively treated patients had good outcome (mRS 0). Three aneurysms (6%) required additional treatment due to aneurysm recurrence.
CONCLUSION
In our series, treatment of intracranial aneurysms with the PED was associated with favorable occlusion rates and low complication rates at mid-term follow-up. The presence of branching vessels arising from the aneurysms sac was predictive for an incomplete occlusion.

Keyword

Intracranial aneurysms; Flow diverter; Pipeline embolization device; Incomplete occlusion

MeSH Terms

Aneurysm
Follow-Up Studies
Humans
Intracranial Aneurysm*
Recurrence
Retreatment
Tertiary Healthcare

Figure

• 

  Fig. 1 Angiogram of a 56-year-old patient (no. 44) shows a saccular supraophthalmic LICA aneurysm with a maximal sac diameter of 4 mm (A, black arrow). Immediately after PED placement (B, C) the intra-aneurysmal filling grade is still >95% (OKM A2, C, arrow). At follow-up after six months the aneurysm is completely occluded (OKM D, D).

• 

  Fig. 2 Recurrence of a paraophthalmic LICA aneurysm in a 53-year-old patient (no. 27) after previous coiling (black arrow) and complete occluded RMCA aneurysm after surgery (A). After PED placement (B) the final angiogram showed a partially occluded aneurysm (OKM B3, image not shown). Approximately eight months after placement no significant change of filling and stasis grades was observed (C).

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