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  • Reduced Efficacy of the Pipeline Embolization Device in the Treatment of Posterior Communicating Region Aneurysms with Fetal Posterior Cerebral Artery Configuration

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    Anil Roy MD; Brian Howard MD; Diogo Haussen MD; Joshua Osbun MD; Sameer Halani BA, MS; Susana Skukalek DNP, NP-C; Frank Tong; Raul Nogueira MD; Jacques Dion MD; C. Cawley MD, FACS; Jonathan Grossberg MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Aneurysms at the origin of the posterior communicating artery (PcommA) have been demonstrated to be effectively treated with the Pipeline Embolization Device (PED) (Daou et al, 2016, Rangel-Castilla et al., 2016). Much less is known about the efficacy of the PED for aneurysms associated with a fetal posterior cerebral artery (fPCA) variant.

    Methods: A prospectively maintained university database of aneurysm patients treated with the PED was retrospectively reviewed. Demographics, treatment details, and imaging were reviewed for all PcommA and fPCA aneurysms.

    Results: Out of a total of 285 patients treated with PED, 50 patients (mean age 57.5 ± 12.2 years, 42 females) with unruptured PcommA (9 fPCA) aneurysms were identified. Mean follow-up duration was 14.0 ± 11.6 months (48 patients). Roy-Raymond Class I occlusion on follow up Magnetic Resonance or catheter angiography (mean time 11.7 ± 6.8 months) was achieved in 30 patients (62.5%), Class II occlusion in 11 patients (22.9%) and Class III occlusion in 7 patients (14.5%). The PcommA was occluded in 56% of patients without any clinical symptoms. No deaths or permanent neurological complications occurred. In fPCA aneurysms, Class I occlusion was seen in 1 patient, Class 2 occlusion in 2 patients, and Class III occlusion in 6 patients. Multivariate analysis revealed an independent association between incomplete occlusion and fPCA configuration (OR 73.65; 95% CI [5.84-929.13]; p=0.001).

    Conclusions: The PED is a safe and effective treatment for Pcomm aneurysms although fetal anatomy should increase consideration of traditional endovascular techniques or surgical clipping.

    Patient Care: This research should guide interventionalists in counseling patients on long term outcomes for Pipeline Embolization treatment of PComm aneurysms and limitations of its treatment for patients with fetal PCA anatomy.

    Learning Objectives: To discuss the efficacy and the PED for the treatment of Pcomm aneurysms and to highlight considerations for patients with fetal PCA anatomy.

    References: 1. Daou B, Valle-Giler EP, Chalouhi N, et al. Patency of the posterior communicating artery following treatment with the Pipeline Embolization Device. J Neurosurg. May 6 2016:1-6. 2. Rangel-Castilla L, Munich SA, Jaleel N, et al. Patency of anterior circulation branch vessels after Pipeline embolization: longer-term results from 82 aneurysm cases. J Neurosurg. Jun 10 2016:1-6

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