Adam N Wallace1, Mudassar Kamran2, Thomas P Madaelil3, Yasha Kayan4, Joshua W Osbun5, Anil K Roy6, Josser E Delgado Almandoz4, Christopher J Moran7, Brian M Howard8, Junaid Yasin2, Jonathan A Grossberg6. 1. Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Department of Radiology, University of Iowa Carver School of Medicine, Iowa City, Iowa, USA. Electronic address: adam.wallace@crlmed.com. 2. Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA. 3. Department of Radiology, Emory University, Atlanta, Georgia, USA. 4. Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA. 5. Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA; Department of Neurosurgery, Washington University, St. Louis, Missouri, USA; Department of Neurology, Washington University, St. Louis, Missouri, USA. 6. Department of Neurosurgery, Emory University, Atlanta, Georgia, USA. 7. Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA; Department of Neurosurgery, Washington University, St. Louis, Missouri, USA. 8. Department of Radiology, Emory University, Atlanta, Georgia, USA; Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
Abstract
BACKGROUND: Flow diversion is a viable alternative for treatment of wide-neck and fusiform aneurysms originating from the posterior inferior cerebellar artery (PICA), but coverage of the PICA and vertebral perforating arteries may be a concern. The aim of this study was to examine procedural, clinical, and angiographic outcomes of patients with PICA aneurysms treated with the Pipeline Embolization Device. METHODS: Retrospective review was performed of PICA aneurysms treated with the Pipeline device at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes. RESULTS: In 16 procedures, 14 PICA aneurysms were treated with the Pipeline device. These included 11 saccular aneurysms with a mean size of 7.4 mm (range, 2.0-11.1 mm) and 3 fusiform aneurysms with a mean diameter of 6.1 mm (range, 5.0-8.0 mm) and mean length of 10.3 mm (range, 6.0-15.0 mm). One patient developed a PICA territory infarct with mild leg weakness that resolved in <7 days. Overall complication rate was 7% (1/14) per patient and 6% (1/16) per procedure. Mean duration of clinical follow-up was 13.5 months (range, 3 weeks to 61.7 months), with all patients returning to baseline functional status. Complete or near-complete aneurysm occlusion was achieved in 58% (7/12) of cases with angiographic follow-up (mean, 15 months; range, 4-61 months). All covered PICAs remained patent. CONCLUSIONS: Flow diversion of PICA aneurysms is a safe and viable treatment option when traditional endovascular options are unlikely to preserve parent vessel patency.
BACKGROUND: Flow diversion is a viable alternative for treatment of wide-neck and fusiform aneurysms originating from the posterior inferior cerebellar artery (PICA), but coverage of the PICA and vertebral perforating arteries may be a concern. The aim of this study was to examine procedural, clinical, and angiographic outcomes of patients with PICA aneurysms treated with the Pipeline Embolization Device. METHODS: Retrospective review was performed of PICA aneurysms treated with the Pipeline device at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes. RESULTS: In 16 procedures, 14 PICA aneurysms were treated with the Pipeline device. These included 11 saccular aneurysms with a mean size of 7.4 mm (range, 2.0-11.1 mm) and 3 fusiform aneurysms with a mean diameter of 6.1 mm (range, 5.0-8.0 mm) and mean length of 10.3 mm (range, 6.0-15.0 mm). One patient developed a PICA territory infarct with mild leg weakness that resolved in <7 days. Overall complication rate was 7% (1/14) per patient and 6% (1/16) per procedure. Mean duration of clinical follow-up was 13.5 months (range, 3 weeks to 61.7 months), with all patients returning to baseline functional status. Complete or near-complete aneurysm occlusion was achieved in 58% (7/12) of cases with angiographic follow-up (mean, 15 months; range, 4-61 months). All covered PICAs remained patent. CONCLUSIONS: Flow diversion of PICA aneurysms is a safe and viable treatment option when traditional endovascular options are unlikely to preserve parent vessel patency.
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