Introduction: The ideal number of pipeline devices used to treat an aneurysm of the internal carotid artery remains a subject of debate.
Methods: We reviewed the results of pipeline flow-diversion for ICA aneurysms from the cavernous through supraclinoid segments performed at a single institution from 2016 through 2017.
Results: 44 ICA aneurysms were treated, and all patients underwent angiographic follow-up (mean=6.8 months). 72.7% of patients were treated with multiple devices (mean=2.4). Occlusion rate at initial follow-up for aneurysms treated with multiple devices was significantly greater than in those treated with a single device (90.6% v. 66.7%, p=0.05). Peri-procedural complication rate did not differ between groups (p=0.46) and no neurologic complications were noted at 30-day follow-up. Of aneurysms treated, 36 measured less than 12mm (mean=5.9mm) and 8 measured 12mm or greater (mean=13.4mm). 92% of aneurysms <12mm treated with multiple devices were occluded at first follow-up; 0% were unprotected. In the single device group, 72.7% of aneurysms <12mm were occluded at first follow-up. Among large aneurysms, 87.5% were treated with multiple devices (mean=2.4), with 85.7% achieving occlusion at 6 months. Only one patient with an aneurysm >12mm was treated with a single device and had persistent filling at 6-month follow-up. The peri-procedural complication rate did not differ between subgroups.
Conclusions: ICA aneurysms treated with multiple Pipeline devices are more likely to be cured at 6-month follow-up compared to those treated with a single device, without an increased risk of peri-operative complication. For small and large aneurysms, those treated with multiple devices tended to have a greater rate of occlusion at initial follow-up, however these did not reach statistical significance. Complication rates did not differ between these groups. Neurosurgeons may consider placing multiple devices in ICA aneurysms to achieve more rapid and more likely cure. This technique may result in reduced need for subsequent angiography and re-treatment.
Patient Care: Deployment of multiple Pipeline devices to treat ICA aneurysms is safe and effective and should be considered to achieve more rapid and more likely cure.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) describe the factors involved in determining optimal number of Pipeline devices to treat ICA aneurysms.
2) identify the merits of achieving more rapid angiographic cure of Pipeline-treated ICA aneurysms.