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  • Pipeline flow diversion as primary treatment for aneurysms of the A1-A2 junction.

    Final Number:

    Justin G. Santarelli MD; Alexa Cohen BA; Chirag D. Gandhi MD, FACS; Jared Blaine Cooper MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting - Late Breaking Science

    Introduction: Anterior communicating artery (Acom) aneurysms historically have been managed by clip ligation or endovascular coiling. Expanding indications for flow diversion allow consideration of pipeline embolization as primary treatment modality for aneurysms of the Acom located eccentrically at the A1-A2 junction.

    Methods: Three patients with unruptured A1-A2 junction aneurysms were treated primarily with Pipeline at a single institution. All patients underwent angiography 6 months after treatment.

    Results: The mean patient age was 63 years. One patient was female and two patients were male. Two patients had suffered prior subarachnoid hemorrhage from unrelated aneurysms. Average A1-A2 junction aneurysm size was 4.2 mm. All aneurysms emerged from the A1-A2 junction and minimally involved the anterior communicating artery. A single pipeline device was used in each case extending from ipsilateral A1 to A2. At 6 month followup angiography, all three aneurysms were excluded from the circulation. There were no peri-procedural complications.

    Conclusions: Pipeline embolization is safe and effective as primary treatment of A1-A2 junction aneurysms. A single implanted device is likely to result in aneurysmal cure in a 6 month time frame.

    Patient Care: Pipeline flow diversion can be considered as a primary treatment modality for A1-A2 junction aneurysms, reducing the need for clip ligation, and achieving more effective cure than other available endovascular techniques.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe treatment considerations for Acom region aneurysms based on angiographic findings. 2) Identify angiographic features that make A1-A2 junction aneurysms favorable to primary pipeline embolization with a single device.


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