N Adeeb1, C J Griessenauer1,2, A A Dmytriw1,3,4, H Shallwani5, R Gupta1, P M Foreman6, H Shakir5, J Moore1, N Limbucci7, S Mangiafico7, A Kumar4, C Michelozzi8, Y Zhang3, V M Pereira3, C C Matouk9, M R Harrigan6, A H Siddiqui5, E I Levy5, L Renieri7, T R Marotta4, C Cognard8, C S Ogilvy1, A J Thomas10. 1. From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts. 2. Department of Neurosurgery (C.J.G.), Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania. 3. Department of Medical Imaging (A.A.D., Y.Z., V.M.P.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. 4. Division of Diagnostic and Therapeutic Neuroradiology (A.A.D., A.K., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada. 5. Department of Neurosurgery (H. Shallwani, H. Shakir, A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York. 6. Department of Neurosurgery (P.M.F., M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama. 7. Department of Interventional Neuroradiology (N.L., S.M., L.R.), University of Florence, Florence, Italy. 8. Department of Diagnostic and Therapeutic Neuroradiology (C.M., C.C.), Toulouse University Hospital, Toulouse, France. 9. Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, Connecticut. 10. From the Beth Israel Deaconess Medical Center (N.A., C.J.G., A.A.D., R.G., J.M., C.S.O., A.J.T.), Harvard Medical School, Boston, Massachusetts athomas6@bidmc.harvard.edu.
Abstract
BACKGROUND AND PURPOSE: Flow diversion with the Pipeline Embolization Device is increasingly used for endovascular treatment of intracranial aneurysms due to high reported obliteration rates and low associated morbidity. While obliteration of covered branches in the anterior circulation is generally asymptomatic, this has not been studied within the posterior circulation. The aim of this study was to evaluate the association between branch coverage and occlusion, as well as associated ischemic events in a cohort of patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. MATERIALS AND METHODS: A retrospective review of prospectively maintained databases at 8 academic institutions from 2009 to 2016 was performed to identify patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. Branch coverage following placement was evaluated, including the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and posterior cerebral artery. If the Pipeline Embolization Device crossed the ostia of the contralateral vertebral artery, its long-term patency was assessed as well. RESULTS: A cohort of 129 consecutive patients underwent treatment of 131 posterior circulation aneurysms with the Pipeline Embolization Device. Adjunctive coiling was used in 40 (31.0%) procedures. One or more branches were covered in 103 (79.8%) procedures. At a median follow-up of 11 months, 11% were occluded, most frequently the vertebral artery (34.8%). Branch obliteration was most common among asymptomatic aneurysms (P < .001). Ischemic complications occurred in 29 (22.5%) procedures. On multivariable analysis, there was no significant difference in ischemic complications in cases in which a branch was covered (P = .24) or occluded (P = .16). CONCLUSIONS: There was a low occlusion incidence in end arteries following branch coverage at last follow-up. The incidence was higher in the posterior cerebral artery and vertebral artery where collateral supply is high. Branch occlusion was not associated with a significant increase in ischemic complications.
BACKGROUND AND PURPOSE: Flow diversion with the Pipeline Embolization Device is increasingly used for endovascular treatment of intracranial aneurysms due to high reported obliteration rates and low associated morbidity. While obliteration of covered branches in the anterior circulation is generally asymptomatic, this has not been studied within the posterior circulation. The aim of this study was to evaluate the association between branch coverage and occlusion, as well as associated ischemic events in a cohort of patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. MATERIALS AND METHODS: A retrospective review of prospectively maintained databases at 8 academic institutions from 2009 to 2016 was performed to identify patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. Branch coverage following placement was evaluated, including the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and posterior cerebral artery. If the Pipeline Embolization Device crossed the ostia of the contralateral vertebral artery, its long-term patency was assessed as well. RESULTS: A cohort of 129 consecutive patients underwent treatment of 131 posterior circulation aneurysms with the Pipeline Embolization Device. Adjunctive coiling was used in 40 (31.0%) procedures. One or more branches were covered in 103 (79.8%) procedures. At a median follow-up of 11 months, 11% were occluded, most frequently the vertebral artery (34.8%). Branch obliteration was most common among asymptomatic aneurysms (P < .001). Ischemic complications occurred in 29 (22.5%) procedures. On multivariable analysis, there was no significant difference in ischemic complications in cases in which a branch was covered (P = .24) or occluded (P = .16). CONCLUSIONS: There was a low occlusion incidence in end arteries following branch coverage at last follow-up. The incidence was higher in the posterior cerebral artery and vertebral artery where collateral supply is high. Branch occlusion was not associated with a significant increase in ischemic complications.
Authors: Christoph J Griessenauer; Christopher S Ogilvy; Paul M Foreman; Michelle H Chua; Mark R Harrigan; Lucy He; Matthew R Fusco; J D Mocco; Christopher J Stapleton; Aman B Patel; Ashish Sonig; Adnan H Siddiqui; Ajith J Thomas Journal: Neurosurgery Date: 2017-04-01 Impact factor: 4.654
Authors: Kelly D Flemming; David O Wiebers; Robert D Brown; Michael J Link; John Huston; Robyn L McClelland; Teresa J H Christianson Journal: Cerebrovasc Dis Date: 2005-08-22 Impact factor: 2.762
Authors: I Szikora; Z Berentei; Z Kulcsar; M Marosfoi; Z S Vajda; W Lee; A Berez; P K Nelson Journal: AJNR Am J Neuroradiol Date: 2010-02-11 Impact factor: 3.825
Authors: Felipe C Albuquerque; Min S Park; Adib A Abla; R Webster Crowley; Andrew F Ducruet; Cameron G McDougall Journal: J Neurointerv Surg Date: 2014-08-04 Impact factor: 5.836
Authors: David O Wiebers; J P Whisnant; J Huston; I Meissner; R D Brown; D G Piepgras; G S Forbes; K Thielen; D Nichols; W M O'Fallon; J Peacock; L Jaeger; N F Kassell; G L Kongable-Beckman; J C Torner Journal: Lancet Date: 2003-07-12 Impact factor: 79.321
Authors: C J Griessenauer; M A Möhlenbruch; P Hendrix; C Ulfert; C Islak; M Sonnberger; T Engelhorn; E Müller-Thies-Broussalis; T Finkenzeller; M Holtmannspötter; J-H Buhk; W Reith; A Simgen; H Janssen; N Kocer; M Killer-Oberpfalzer Journal: AJNR Am J Neuroradiol Date: 2020-02-27 Impact factor: 3.825
Authors: Yafell Serulle; Deepak Khatri; Jada Fletcher; Anna Pappas; Audrey Heidbreder; David Langer; Rafael A Ortiz Journal: Surg Neurol Int Date: 2020-10-08