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  • Management of Complex intracranial Aneurysms with a Single Pipeline Embolization Device: Case Series of 40 Patients Treated at a Single Center

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    Oluwaseun Omofoye MD, MS; Eddie Yap; Deanna M. Sasaki-Adams md; Sten Solander MD

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    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: The advent of the Pipeline Flow-diverter Embolization Device has significantly increased the scope of endovascular management of intracranial aneurysms. It provides therapeutic option for complex aneurysms that were previously an enigma in management. We present the results from a single-center experience using the Pipeline Flow-diverter Embolization Device.

    Methods: 47 intracranial aneurysms in 40 consecutive patients treated with a single Pipeline Embolization Device between March 2012 and February 2015 were included in our analysis. The clinical, procedural and angiographic data were reviewed. The patients’ demographic data, presenting symptoms, aneurysm size and location, procedural complications, fluoroscopy time, and percentage of cases with stenosis and residual flow at the most recent follow-up visit were analyzed. Aneurysm bleeding and rebleeding rates were also evaluated.

    Results: Ages ranged from 29 to 77 years, and only 10% were males. 33% of the patients had a prior coil embolization with neck remnant or coil-compaction. Our largest treated aneurysm was 34 by 22mm, with an average of 10 by 9mm overall. A single device was used in all cases. The average fluoroscopy time was 32 minutes. The average follow-up interval was 9 months but ranged from 0 to 28 months. There was a 0% procedural vessel branch occlusion rate. 62% of all treated aneurysms in patients with at least one follow-up visit demonstrated complete resolution on repeat imaging. 26% had near-complete occlusion, and only 4% of the treated aneurysms had mild in-stent stenosis.

    Conclusions: The Pipeline Embolization Device is a safe and useful tool in the management of complex intracranial aneurysms. A single pipeline device provides a high aneurysmal obliteration rate with a low risk of complications. However, long term follow up is still needed to determine the durability of results.

    Patient Care: It provides evidence that the Pipeline Embolization Device is a safe and effective tool for treating complex intracranial aneurysms. It also provides clinical evidence that a single pipeline device has a high aneurysmal obliteration rate and a low risk of complications. This will hopefully popularize the use of this device and encourage more neuro-endovascular surgeons to consider it as another tool in their armamentarium of treating intracranial aneurysm.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of the Pipeline Embolization Device in treating complex intracranial aneurysms, 2) Discuss, in small groups, the benefits and risks of using a single pipeline device for treating complex intracranial aneurysms, 3) Identify that long-term follow-up is still needed to determine the durability of results of pipeline device use.


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