Introduction: The Pipeline embolization device (PED) has become an increasingly utilized tool for the treatment of intracranial aneurysms. While its high metal surface area coverage facilitates aneurysm thrombosis, there is concern for the patency of branch vessels covered by the PED. Thus far, limited data exists regarding the patency of branch vessels adjacent to aneurysms that are covered by PEDs.
Methods: We retrospectively reviewed the records of 82 patients who underwent PED treatment between 2009 and 2014 and in whom the PED was identified to cover branch vessels. Patency of the ophthalmic (OphA), posterior communicating (PCOM), and anterior choroidal (AChA) arteries was evaluated by DSA immediately after PED deployment and at routine follow-up. All patients also underwent clinical evaluation during this period.
Results: We identified no instances of branch vessel occlusion immediately following PED placement. Follow-up angiography (mean 7.2 months) demonstrated occlusion of the OphA in 8/76 cases (10.5 %) and of the PCOM in 3/28 cases (10.7%). Only the adult-subtype of the PCOM showed vessel occlusion (3/24 cases, 13%). The fetal-subtype of the PCOM and the anterior choroidal arteries were resistant to occlusion in 4 and 21 cases, respectively. The patients in whom branch vessel occlusion was observed experienced no adverse clinical sequelae.
Conclusions: PED deployment can result in occlusion of branch vessels (ophthalmic and adult PCOM) that have collateral blood flow. Terminal branch vessels (particularly fetal PCOM and AChA) remain patent despite PED coverage likely from a pressure gradient that promotes flow. We conclude PEDs are safe for treatment of ICA aneurysms despite their effect on some branch vessels.
Patient Care: Identify the frequency of ICA branch vessel occlusion and their clinical sequelae after PED deployment
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the role of PEDs in aneurysm treatment; and 2) Identify the vessels prone to occlusion after coverage by PEDs