Introduction: The Pipeline Embolization Device (PED) represents a breakthrough in the treatment of intracranial aneurysms. We analyzed one of the largest cohort of internal carotid artery aneurysms treated with the PED to assess procedural variables and clinical outcomes in a robust patient population.
Methods: We identified 99 patients, harboring 137 unruptured ICA aneurysms. Data recorded and analyzed included aneurysm characteristics, periprocedural variables, and early clinical outcomes as well as outcomes at latest follow up.
Results: Forty eight aneurysms were located in the ophthalmic ICA, 27 in the cavernous ICA, 27 in the posterior communicating, 26 in the superior hypophyseal, and 3 each in the carotid cave, anterior choroidal, and posterior ICA wall. Seven aneurysms were giant, 21 were large, and 101 were small (< 10 mm). Mean aneurysm size was 7.7 mm. Mean number of PED’s per case was 1.18. In 97 procedures, a single PED was use; while = 3 PED’s were used in only 5 procedures. Coiling was required in 12% of procedures and balloon angioplasty was performed in 30% of cases. The rate of periprocedural complications was 5.3% (6/113), 2 of them (1.8%) with permanent deficits. One patient developed in-stent thrombosis 8 days after the procedure due to antiplatelet regimen discontinuation. One patient harboring a giant ophthalmic aneurysm suffered a delayed rupture 5 days after discharge. Two patients had minor hemorrhage within 30 days. During follow up (mean: 9.6 months) 3 patients died (pulmonary embolism, subdural hematoma, and sudden death). Four patients had mRS score = 3, all remaining patients had excellent functional outcome (mRS = 2).
Conclusions: Our study supports the premise that treatment of ICA aneurysms with PED has a rate of complications comparable to stent-assisted coiling and other endovascular techniques. Careful patient selection and adequate antiplatelet regimen are paramount to obtain comparable satisfactory clinical results.
Patient Care: My research will raise awareness of the outcomes obtained with Pipeline Embolization Device for the treatment of the most frequent intracranial aneurysms found in clinical practice.
Learning Objectives: By the conclusion of the session, participants should be able to: 1) Understand the indications for Pipeline Embolization Device, 2) Identify the pros and cons involving the treatment of ICA aneurysms with Pipeline Embolization Decive, 3) Determine whether Pipeline Embolization is an appropriate treatment option for ICA aneurysms.