Introduction: The use of flow diverters in the treatment of unruptured intracranial aneurysms signifies an exciting new treatment option, particularly for large, giant and wide necked aneurysm. We present our initial experience with Pipeline flow diverters for unruptured intracranial aneurysm in 72 patients and 84 aneurysms.
Methods: We performed a retrospective review of our cerebrovascular database for all patients undergoing pipeline deployment for unruptured intracranial aneurysms from May 2011 - March 2012.
Results: A total of 72 patients underwent treatment by pipeline flow diverters for a total of 84 aneurysms. Median age was 55 yrs (range 36-84 yrs). 65 patients were treated for anterior ciruclation aneurysms and 7 patients for posterior circulation aneurysms. All patients were on dual anti-platelet therapy prior to treatment and monitored by ASA function test and P2Y12. There was no mortality in our series with one serious morbidity (1 %) due to a delayed rupture of a giant ophthalmic artery aneurysm. One patient experienced a retroperitoneal hemorrhage and one showed a distal minimal subarachnoid hemorrhage on the first postoperative date resulting in a total morbidity of 4%. No patient experienced ischemic events or symptomatic perforator occlsuions. Of 34 patients undergoing formal angiographic follow-up of 6 months, 29 showed complete aneurysm occlusion (85%) and 5 patients showed partial aneurysm occlusion. No in-stent stenosis was noted in our series.
Conclusions: Pipeline flow diverters offer a new treatment option for previously challenging large, giant or wide necked aneurysms by flow disruption and aneurysm thrombosis. In our initial series, good aneurysm occlusion rates were achieved with a low complication rate. However, further experience is needed to understand the mechanism of complications, particularly, of delayed ruptures for flow diverters to become a standard in the armamentarium of aneurysm treatment.
Patient Care: The use of flow diverters is an important new treatment modality. There is limited data in respect to safety and efficacy of this new device. Our series contributes to our understanding of the use of this new treatment options in regard to technical aspects, complications and outcome.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the indication of flow diverters 2) Discuss adavantages and disadvantages of flow diverters 3) Be familiar with technical aspects of flow diverter use.