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  • Pipeline Embolization Flow Diversion for Dissecting Posterior Circulation Branch Artery Aneurysms

    Final Number:
    296

    Authors:
    Robert WJ Ryan MD FRCS(C) MSc; Genevieve Smith BSN, MSN, ACNP-bc; Armen Choulakian MD; Amir Khan

    Study Design:
    Other

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2017 Annual Meeting

    Introduction: Pipeline Embolization Flow diversion has been shown to be a safe and effective method to treat unruptured anterior circulation aneurysms with morphology that is not conducive to conventional endovascular treatments. However, use of these devices for treatment of posterior circulation aneurysms has been associated with higher complication rates. Additionally, treatment during the acute setting of subarachnoid hemorrhage has not been well studied, likely due to the need for dual antiplatelet therapy. The purpose of this study is to evaluate the safety and feasibility of using a Pipeline Embolization Device (PED) to treat dissecting posterior circulation aneurysms with or without acute subarachnoid hemorrhage.

    Methods: We describe a retrospective case series of 4 patients (3 men, 1 woman; mean age 55) who present with posterior circulation dissecting cerebral aneurysms, not amenable to conventional treatment, who underwent treatment with PED. Three out of four were treated during the acute phase of subarachnoid hemorrhage. The other patient underwent PED placement following recanalization of his aneurysm after prior coil embolization treatment. All received dual antiplatelet load followed by daily dosing and monitoring of serum levels. Of note, on admission 3 patients tested positive for methamphetamine use.

    Results: PED deployment was successful in all 4 cases. Angiographic aneurysm occlusion and patency of parent vessel was noted on 6 month follow up in 2 cases. The other patients are scheduled for future follow-up. No perioperative stroke, aneurysm re-rupture or worsening hemorrhage occurred. One patient was noted to have migration of the PED device on follow up without any associated morbidity or aneurysm recanalization.

    Conclusions: PED is a feasible method of treatment for dissecting posterior circulation aneurysms, including post subarachnoid hemorrhage, when other treatment options are limited. While the requirement for dual antiplatelet therapy has risks following subarachnoid hemorrhage, in our experience, no incidents of stroke, rebleeding or rerupture occurred.

    Patient Care: Provide novel treatment strategy for management of difficult posterior circulation dissecting aneurysms

    Learning Objectives: 1) Describe an alternative treatment option for posterior circulation dissecting cerebral aneurysms where other treatment options may carry high risk. 2) Discuss use of dual antiplatelet therapy following acute subarachnoid hemorrhage

    References:

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