David C Lauzier1, Brandon K Root1, Yasha Kayan2, Josser E Delgado Almandoz2, Joshua W Osbun1,3,4, Arindam R Chatterjee1,3,4, Kayla L Whaley5, Megan E Tipps5, Christopher J Moran1,3, Akash P Kansagra1,3,4. 1. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA. 2. Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA. 3. Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA. 4. Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA. 5. Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Abstract
BACKGROUND AND PURPOSE: Flow diversion of aneurysms located in the M1 segment and middle cerebral artery bifurcation with Pipeline embolization device is sometimes performed, but further study is needed to support its regular use in aneurysm treatment. Here, we report measures of safety and efficacy for Pipeline embolization in the proximal middle cerebral artery in a multi-center cohort. MATERIALS AND METHODS: Clinical and angiographic data of eligible patients were retrospectively obtained from participating centers and assessed for key clinical and angiographic outcomes. Additional details were extracted for patients with complications. RESULTS: In our multi-center cohort, complete aneurysm occlusion was achieved in 71% (17/24) of treated aneurysms. There were no deaths or disabling strokes, but non-disabling ischemic strokes occurred in 8% (2/24) of patients. For aneurysms in the M1 segment, complete aneurysm occlusion was observed in 75% (12/16) of aneurysms, aneurysm volume reduction was observed in 100% (16/16) of aneurysms, and non-disabling ischemic strokes occurred in 13% (2/16) of patients. For aneurysms at the middle cerebral artery bifurcation, complete aneurysm occlusion was observed in 63% (5/8) of aneurysms, aneurysm volume reduction occurred in 88% (7/8) of aneurysms, and ischemic or hemorrhagic complications occurred in 0% (0/8) of patients. CONCLUSION: Pipeline embolization of cerebral aneurysms in the M1 segment and middle cerebral artery bifurcation demonstrated a 71% rate of complete aneurysm occlusion. There were no deaths or disabling strokes, but there was an 8% rate of non-disabling ischemic strokes.
BACKGROUND AND PURPOSE: Flow diversion of aneurysms located in the M1 segment and middle cerebral artery bifurcation with Pipeline embolization device is sometimes performed, but further study is needed to support its regular use in aneurysm treatment. Here, we report measures of safety and efficacy for Pipeline embolization in the proximal middle cerebral artery in a multi-center cohort. MATERIALS AND METHODS: Clinical and angiographic data of eligible patients were retrospectively obtained from participating centers and assessed for key clinical and angiographic outcomes. Additional details were extracted for patients with complications. RESULTS: In our multi-center cohort, complete aneurysm occlusion was achieved in 71% (17/24) of treated aneurysms. There were no deaths or disabling strokes, but non-disabling ischemic strokes occurred in 8% (2/24) of patients. For aneurysms in the M1 segment, complete aneurysm occlusion was observed in 75% (12/16) of aneurysms, aneurysm volume reduction was observed in 100% (16/16) of aneurysms, and non-disabling ischemic strokes occurred in 13% (2/16) of patients. For aneurysms at the middle cerebral artery bifurcation, complete aneurysm occlusion was observed in 63% (5/8) of aneurysms, aneurysm volume reduction occurred in 88% (7/8) of aneurysms, and ischemic or hemorrhagic complications occurred in 0% (0/8) of patients. CONCLUSION: Pipeline embolization of cerebral aneurysms in the M1 segment and middle cerebral artery bifurcation demonstrated a 71% rate of complete aneurysm occlusion. There were no deaths or disabling strokes, but there was an 8% rate of non-disabling ischemic strokes.
Authors: Kathryn M Wagner; Visish M Srinivasan; Aditya Srivatsan; Michael G Z Ghali; Ajith J Thomas; Alejandro Enriquez-Marulanda; Abdulrahman Y Alturki; Christopher S Ogilvy; Maxim Mokin; Anna L Kuhn; Ajit Puri; Ramesh Grandhi; Stephen Chen; Jeremiah Johnson; Peter Kan Journal: J Neurosurg Date: 2019-01-11 Impact factor: 5.115
Authors: J Caroff; H Neki; C Mihalea; F D'Argento; H Abdel Khalek; L Ikka; J Moret; L Spelle Journal: AJNR Am J Neuroradiol Date: 2015-09-24 Impact factor: 3.825
Authors: Leonardo Rangel-Castilla; Stephan A Munich; Naser Jaleel; Marshall C Cress; Chandan Krishna; Ashish Sonig; Kenneth V Snyder; Adnan H Siddiqui; Elad I Levy Journal: J Neurosurg Date: 2016-06-10 Impact factor: 5.115
Authors: Ricardo A Hanel; David F Kallmes; Demetrius Klee Lopes; Peter Kim Nelson; Adnan Siddiqui; Pascal Jabbour; Vitor M Pereira; Istvan Szikora István; Osama O Zaidat; Chetan Bettegowda; Geoffrey P Colby; Maxim Mokin; Clemens Schirmer; Frank R Hellinger; Curtis Given Ii; Timo Krings; Philipp Taussky; Gabor Toth; Justin F Fraser; Michael Chen; Ryan Priest; Peter Kan; David Fiorella; Don Frei; Beverly Aagaard-Kienitz; Orlando Diaz; Adel M Malek; C Michael Cawley; Ajit S Puri Journal: J Neurointerv Surg Date: 2019-07-15 Impact factor: 5.836