Introduction: Flow diversion has emerged as a highly effective treatment for intracranial aneurysms. We assess the yield of further angiographic follow-up in aneurysms that have achieved adequate occlusion after treatment with the Pipeline Embolization Device (PED).
Methods: This is a single institution, retrospective study. Inclusion criteria were as follows: 1) patients with one or more aneurysms treated with PED, 2) available shortterm
(<12 months) follow-up digital subtraction angiography (DSA), 3) complete
(100%) or near-complete (>95%) occlusion on short-term follow-up DSA, and 4)
available further angiographic follow-up (DSA, MRA, or CTA).
Results: A total of 146 patients were identified. Aneurysm size was 8.4 ± 5.1 mm on
average. Mean angiographic follow-up time was 29.7 ± 12.2 months. On short-term
follow-up DSA images, 132 (90.4%) had complete aneurysm occlusion and 14 (9.6%)
had near-complete occlusion. Four patients (3%) had further DSA follow-up alone, 30
patients (21%) had further DSA and MRA/CTA follow-up, and 112 patients (76%) had
further MRA/CTA follow-up alone. On further angiographic follow-up (DSA, MRA,
and/or CTA), no patient had a decrease in the degree of aneurysm occlusion
(recurrence) or required retreatment. Of the 14 patients with near-complete occlusion
on initial DSA images, 7 patients (50%) progressed to complete aneurysm occlusion
on further angiographic follow-up.
Conclusions: This study did not find any diagnostic yield in repeating cerebral
angiography in adequately occluded aneurysms with the PED.
Patient Care: This study promotes the reduction of unnecessary follow-up neuro-imaging for healed intracranial aneurysms. This should play a major role in redefining the follow-up protocols of treated aneurysms and reducing the reltaed costs for all the patients.
Learning Objectives: We do not recommend
repeat angiographic follow-up once aneurysms have achieved complete occlusion with
the PED unless clinically warranted.