Stephanie H Chen1, David J McCarthy2, Dallas Sheinberg1, Ricardo Hanel3, Samir Sur1, Pascal Jabbour4, Elias Atallah4, Nohra Chalouhi4, Aaron Dumont5, Peter Amenta5, David Hasan6, Daniel Raper7, Kenneth Liu7, John A Jane7, R Webster Crowley8, Pedro Aguilar-Salinas9, Josh Bentley10, Stephen Monteith10, Bartley D Mitchell11, Dileep R Yavagal1, Eric C Peterson1, Robert M Starke1. 1. Department of Neurological Surgery, University of Miami, Miami, Florida, USA. 2. Department of Neurological Surgery, University of Miami, Miami, Florida, USA. Electronic address: djm77@med.miami.edu. 3. Department of Neurological Surgery, University of Miami, Miami, Florida, USA; Department of Neurological Surgery, Baptist Health, Miami, Florida, USA. 4. Department of Neurological Surgery, Jefferson University, Philadelphia, Pennsylvania, USA. 5. Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA. 6. Department of Neurological Surgery, University of Iowa, Iowa City, Iowa, USA. 7. Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA. 8. Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA. 9. Department of Neurological Surgery, Baptist Health, Miami, Florida, USA. 10. Department of Neurological Surgery, Swedish Health, Seattle, Washington, USA. 11. Department of Neurological Surgery, Methodist Institute, Houston, Texas, USA.
Abstract
BACKGROUND: Intracranial pseudoaneurysms (PSAs) are associated with high rupture and mortality rates and have traditionally been treated by parent vessel sacrifice. There has been recent interest in using flow-diverting devices for treatment of these complex lesions while preserving flow through the parent artery. The objective of this study is to examine the safety and efficacy of these devices in the treatment of intracranial PSA. METHODS: We performed a multi-institutional retrospective study of intracranial PSAs treated with the Pipeline Embolization Device (PED) between 2014 and 2017 at 7 institutions. Complications and clinical and radiographic outcomes were reviewed. RESULTS: A total of 19 patients underwent PED placement for intracranial PSA. Iatrogenic injury and trauma comprised most etiologies in our series. The mean pseudoaneurysm diameter was 8.8 mm, and 18 of 19 PSAs (95%) involved the internal carotid artery (ICA). Multiple PEDs were deployed in a telescoping fashion in 7 patients (37%). Of the 18 patients with follow up imaging, 14 (78%) achieved complete pseudoaneurysm obliteration and 2 achieved near-complete obliteration (11%). Two patients (11%) were found to have significant pseudoaneurysm progression on short-term follow-up and required ICA sacrifice. No patients experienced new neurologic deficits or deterioration secondary to PED placement. No patients experienced bleeding or rebleeding from PSA. CONCLUSIONS: In well-selected patients, the use of flow-diverting stents may be a feasible alternative to parent vessel sacrifice. Given the high morbidity and mortality associated with PSA, we recommend short- and long-term radiographic follow-up for patients treated with flow-diverting stents.
BACKGROUND:Intracranial pseudoaneurysms (PSAs) are associated with high rupture and mortality rates and have traditionally been treated by parent vessel sacrifice. There has been recent interest in using flow-diverting devices for treatment of these complex lesions while preserving flow through the parent artery. The objective of this study is to examine the safety and efficacy of these devices in the treatment of intracranial PSA. METHODS: We performed a multi-institutional retrospective study of intracranial PSAs treated with the Pipeline Embolization Device (PED) between 2014 and 2017 at 7 institutions. Complications and clinical and radiographic outcomes were reviewed. RESULTS: A total of 19 patients underwent PED placement for intracranial PSA. Iatrogenic injury and trauma comprised most etiologies in our series. The mean pseudoaneurysm diameter was 8.8 mm, and 18 of 19 PSAs (95%) involved the internal carotid artery (ICA). Multiple PEDs were deployed in a telescoping fashion in 7 patients (37%). Of the 18 patients with follow up imaging, 14 (78%) achieved complete pseudoaneurysm obliteration and 2 achieved near-complete obliteration (11%). Two patients (11%) were found to have significant pseudoaneurysm progression on short-term follow-up and required ICA sacrifice. No patients experienced new neurologic deficits or deterioration secondary to PED placement. No patients experienced bleeding or rebleeding from PSA. CONCLUSIONS: In well-selected patients, the use of flow-diverting stents may be a feasible alternative to parent vessel sacrifice. Given the high morbidity and mortality associated with PSA, we recommend short- and long-term radiographic follow-up for patients treated with flow-diverting stents.