Introduction: Anterior communicating artery (AcoA) aneurysms represent a challenge for open and endovascular surgery. Flow diversion is a increasingly accepted treatment for a variety of intracranial aneurysms. We present a large, single-center case series of patients with AcoA region aneurysms that were treated using the Pipeline embolization device (PED).
Methods: A single-center prospectively collected aneurysm database was reviewed to identify patients who underwent endovascular embolization of AcoA region aneurysms with PED.
Results: 37 patients underwent 44 procedures for treatment of ACoA region aneurysms with the PED, of which 42 (95%) were successfully completed. Six patients had bilateral stents placed in an H-configuration. Nineteen patients were female (51%) and the average age was 57 years. The average aneurysm size was 4.6mm +/-3.0mm. Seventeen patients (46%) had prior subarachnoid hemorrhage (SAH). Six aneurysms were previously clipped (16%), 12 were previously coiled (32%), and 19 had no prior treatment (51%). PED were placed from A1 to ipsilateral A2 in 40 cases (95%) and to the contralateral A2 in two cases (5%). Balloon angioplasty was employed in three cases (7%) and coils were used adjunctively in two cases (5%). Mean follow-up duration was 8.8 months, at which time 28/32 (95%) of aneurysms were occluded. Follow-up data was not available for 10 patients; eight were within six months of stent placement and two were lost to follow-up. Complications included transient neurological deficit in two patients (5%), one with small ipsilateral ICH. Two patients experienced in-stent thrombosis, with one resulting in major stroke. Zero patients had post-procedural SAH. There were zero mortalities. Overall, major, permanent neurological deficit occurred in 1/44 cases (2.2%) or 1/37 patients (2.7%).
Conclusions: The PED can be used safely and effectively in the treatment of ACoA-region aneurysms. This represents a good alternative treatment option in addition to microsurgical clipping and endovascular coiling.
Patient Care: This introduces flow diversion as a novel treatment for anterior communicating artery aneurysms
Learning Objectives: 1. Understand applications of the pipeline embolization device (PED)
2. Consider the treatment alternatives for anterior communicating artery-region aneurysms
3. Evaluate the efficacy and complications associated with PED treatment of ACoA-region aneurysms