TITLE:
Complications, imaging results, and midterm clinical outcomes of pipeline embolisation device in the treatment of cerebral aneurysms
AUTHORS:
Hamed Asadi, Timothy Phillips, Richard Dowling, Bernard Yan, Peter Mitchell
KEYWORDS:
Cerebral Aneurysm; Flow Diverting Stents; Pipline Embolisation Device; Endovascular Treatment
JOURNAL NAME:
World Journal of Neuroscience,
Vol.4 No.1,
February
11,
2014
ABSTRACT: Background: The
introduction of pipeline embolisation device (PED) has improved the feasibility
of endovascular treatment of intracranial aneurysms. The device allows for
endoluminal reconstruction across the aneurysm neck but is permeable enough
that flow is preserved across the pressure gradients into sidebranch
arteries. In spite of higher rates of aneurysm occlusion, there is lack of data
concerning medium to long-term clinical and imaging results. Methods: This
study was a prospective single center analysis of complications, imaging
results, and medium term clinical outcomes after PED treatment of intracranial
aneurysms. We included cases over a 17-month period in a tertiary
interventional neuroradiology center. We collected data on demographics,
vascular risk factors, clinical presentation, angiographic results post treatment,
angiographic follow-up and clinical follow-up. Results: Thirty-three patients
were included, 25 females and 8 males, with mean age of 55 years; 3 presented
with acute subarachnoid hemorrhage and 30 for elective treatment. Thirty-seven
aneurysms were treated: 35 Internal Carotid Artery (ICA), 1 basilar trunk fusiform,
and 1 vertebral artery intradural dissecting aneurysms. No deaths have
occurred. Five patients suffered transient neurological complications (15%).
Overall aneurysm occlusion was demonstrated in 85% of patients at the end of
one year. Discussion:Overall, the technique of flow
diversion and endoluminal reconstruction differs greatly from the established
endosaccular packing techniques of standard coiling, balloon remodeling, or
stent assisted coiling. Our midterm follow-up confirms that, the rates of
clinically significant complications compare favorably with published data on
stent assisted coiling, potentially making these devices a truly revolutionizing
technique.