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  • De novo vs Salvaged Posterior Communicating Artery Segment Aneurysms Treated with Pipeline Embolization Device

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    Alejandro Enriquez-Marulanda MD; Mohamed M Salem MD; Luis C Ascanio MD; Krishnan Ravindran BS; Peter Kan MD, MPH, FAANS, FRCSC; Visish M. Srinivasan MD; Christoph Johannes Griessenauer MD; Clemens M. Schirmer MD PhD; Justin M Moore B.Med.Sci (hon), MD, PhD; Christopher S. Ogilvy MD; Ajith J. Thomas MD; Abdulrahman Alturki

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Pipeline embolization device (PED) has been well recognized as an effective modality for management of select intracranial aneurysms. However, little is known about the utility of the PED in the treatment of posterior communicating segment artery (PComA) aneurysms and how previous treatment (microsurgical clipping or endovascular coiling) could impact these aneurysms’ response to salvage flow diversion. Therefore, we sought to compare PED effectiveness in de novo versus salvaged PComA segment aneurysms and evaluate if previous treatment could potentially affect occlusion rates and clinical outcomes.

    Methods: We conducted a multicenter retrospective review of 3 prospectively collected databases between January 2013 and December 2017 of patients with saccular PComA aneurysms treated with PED. All statistical analyses were conducted using STATA 14, with p-values set <0.05 for significance.

    Results: A total of 57 patients harboring 60 saccular aneurysms were included in this cohort; mean age was 60.5 years, with female patients constituting the majority of the population (86%, n=49). Thirteen (22.8%) patients were either current smokers or had significant history of smoking. Prior to treatment, 55 (91.7%) aneurysms were unruptured. The median radiographic follow-up was 8.5 months, ranging from 6 to 18 months. Complete occlusion at latest follow-up was achieved in 84% of aneurysms. Out of the 18 previously treated aneurysms, 12 (66.7%) were coiled and 6 (33.3%) were microsurgically clipped. Patients undergoing salvage treatment were older (p<0.01) and more likely to be smokers (p=0.03). There was an observed trend for previously treated aneurysms to achieve complete occlusion at last available follow up when compared to de novo aneurysms that did not occlude (28.6% vs 0%; p 0.08). Favorable functional outcome at last follow-up (mRS 0-2) was recorded in 94.4% of patients.

    Conclusions: Salvage treatment of aneurysms in the PComA segment using PED is a safe and effective modality with high occlusion rates.

    Patient Care: Treatment with PED of posterior communicating artery segment aneurysms, that failed previous microsurgical or endovascular therapies, should be considered as an efficacious and safe alternative.

    Learning Objectives: 1. Salvage treatment of posterior communicating artery segment aneurysms with flow-diversion therapy is safe and efficacious. 2. Flow diversion therapy is a versatile treatment for intracranial aneurysms that has proven to be efficacious anatomically complex aneurysms that are technically challenging for conventional microsurgical or endovascular therapies


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