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  • Pipeline Flow Diversion of High Cervical and Intracranial Dissecting Aneurysms and Pseudoaneurysms: A Single-Institution Series of 39 Consecutive Cases

    Final Number:

    Bowen Jiang MD; Matthew T Bender MD; Erick M Westbroek MD; Risheng Xu AB AM MD PhD; Jessica K. Campos MD; Li-Mei Lin BA; Rafael J Tamargo; Judy Huang MD; Geoffrey P. Colby MD, PhD; Alexander L. Coon MD

    Study Design:

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2018 Annual Meeting

    Introduction: Dissecting and pseudo-aneurysms of the brain and cervical vasculature present unique therapeutic challenges. There are limited reports of flow diversion for the treatment of these aneurysms

    Methods: A prospective, IRB-approved database was analyzed for all patients with dissecting aneurysms and pseudo-aneurysms treated by Pipeline flow diversion (PED) at our institution.

    Results: A total of 39 consecutive cases were selected for analysis. The average aneurysm size was 8.4mm +/- 4.3mm and average patient age was 50 years +/- 15 years (range 8 months to 77 years). Morphology was dissecting in 33/39 (85%) and pseudo in 6/39 (15%) cases. 5 cases (13%) received prior treatment and 3 cases (8%) presented with acute subarachnoid hemorrhage. 25 cases (64%) were in the anterior circulation and 14 (36%) in the posterior circulation. Cervical and petrous internal carotid artery aneurysms accounted for 44% of the cases. 33% (13/39) required more than one PED. Adjunctive coiling was performed in 8% of cases. The average length of stay was 4.4 days with 77% patients discharged home on post-embolization day 1 or 2. The overall major complication rate was 2.5%, with one patient suffering an ischemic stroke. The minor complication rate was 5%, which accounts for two TIAs. All complications were from posterior circulation cases. There were no procedural related hemorrhages. Follow up catheter angiography was available on 28/39 patients (72%) at an average of 11 months. Complete occlusion was 75% at 6 months and 79% at 12 months. Of those without complete occlusion (n=6), 1 case had complete occlusion at 24 months, 3 had trace filling, and 2 had persistent filling.

    Conclusions: This is a large single-institution series of Pipeline for dissecting and pseudo-aneurysms and demonstrates low complication rates and high obliteration rates for these challenging cases.

    Patient Care: Dissecting and pseudoaneurysms of the brain and upper cervical spine present unique therapeutic challenges. The use of new flow diversion technology is being more widely adopted for the treatment of these aneurysms. A large series that discusses nuances and long term outcomes will stimulate discourse about the role of Pipeline for these pathologies.

    Learning Objectives: To learn the utility and safety of flow diversion for high cervical and intracranial dissecting and pseudoaneurysms.


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