Introduction: The Pipeline Embolization Device has demonstrated safety and efficacy in a variety of off-label applications, with limited reports of its use for aneurysms along the middle cerebral artery.
Methods: Patients with MCA aneurysms treated with flow diversion were identified. Follow-up angiography was performed at 6 and 12 months. Occlusion was graded as complete, trace filling, entry remnant, or aneurysm filling. Clopidogrel was discontinued at 6 months; aspirin was reduced to 81mg from 325mg daily at 12 months.
Results: There were 40 cases of flow diversion for 41 MCA aneurysms, with 93%(38/40) successful rate. Twenty-nine patients(76%) were female. Average age was 53±15years, average size 5.4±4.7mm, neck size 2.7±1.1mm. Ten aneurysms arose from M1(26%), 22 MCA bifurcation(58%), 5 M2(13%) and 1 distal MCA(3%). Average size of MCA bifurcation aneurysms was 5.2mm(1.8-15mm), neck size 3mm(1.5-5.5mm). Thirteen cases(34%) had previous treatment, and 14(37%) had subarachnoid hemorrhage. Morphology was 89%saccular, 8%fusiform and 1%dissecting. Balloon remodeling was performed in 2 cases(5%), adjunctive coiling in 4 cases(11%). There were 2 in-situ thromboses(5%). One occurrence resolved following abciximab administration with no clinical significance. The other, an irregular right MCA bifurcation aneurysm treated with PED and coiling, was complicated by intra-procedural in-stent platelet accumulation and resolved with abciximab administration, however, the patient suffered left lower extremity paresis with mRS4 at last follow-up. This was the only major complication(1/38;2.6%), and no mortalities. Minor complications(3/38;8%) included one minor stroke, one asymptomatic ICA dissection, and one post-operative cranial nerve III palsy without evidence for carotid cavernous fistula.
Follow-up angiography was available for 34/38(89%) cases at average 12.4 months. Complete occlusion was achieved in 66%(n=25), and 74%(n=28), at 6-, and 12-months, respectively. Of 14/19 MCA bifurcation aneurysms with available follow-up, 74% were completely occluded at average 11 months.
Conclusions: Treatment of MCA aneurysms with PED offers a favorable occlusion rate(74%) with acceptable major complication rate(2.6%).
Patient Care: Improved understanding of the safety and efficacy of flow diversion embolization using the Pipeline embolization device when treating cerebral aneurysms along the middle cerebral artery.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the safety and efficacy of flow diversion embolization in treating MCA aneurysms