Abstract
Introduction
Flow diversion is being increasingly used to treat cerebral aneurysms. We present our experience using these stents to treat aneurysms distal to the circle of Willis with parent arteries smaller than 2.5 mm.
Methods
Aneurysms treated with a Pipeline™ Embolization Device in vessels less than 2.5 mm between June 2012 and August 2014 were included. We evaluated risk factors, family history of aneurysms, aneurysm characteristics, National Institute of Health Stroke Scale (NIHSS), and modified Rankin scale (mRS) on admission and angiography and clinical outcome at discharge, 6 months, and 1 year.
Results
We included seven patients with a mean age of 65 years. The parent vessel size ranged from 1.5 to 2.3 mm; mean 1.9 mm. Location of the aneurysms was as follows: two aneurysms centered along the pericallosal artery (one left, one right), one on the right angular artery, one aneurysm at the anterior communicating artery (ACom), one at the ACom-right A2 anterior cerebral artery (ACA), one at the lenticulostriate artery, and one at the A1-A2 ACA artery. Aneurysms ranged from 1 to 12 mm in diameter. All aneurysms were treated with a single Pipeline™ Embolization Device (PED). No peri- or post-procedural complications or mortality occurred. The patients were discharged with no change in NIHSS or mRS score. Angiographic follow-up was available in six patients. Angiography showed complete aneurysm occlusion in all. NIHSS and mRS remained unchanged at follow-up.
Conclusion
Our preliminary results show that flow diversion technology is an effective and safe therapy for aneurysms located on small cerebral arteries. Larger studies with long-term follow-up are needed to validate our promising results.
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We declare that all human and animal studies have been approved by the Institutional Review Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.
Conflict of interest
ASP consults for Codman Neurovascular and Covidien and has research grants from Stryker Neurovascular and Covidien. AKW consults for Stryker Neurovascular, has a research grant from Philips Healthcare and the Wyss Institute and speaks for the Harvard Postgraduate Course and Miami Cardiovascular Institute. MJG consults for Codman Neurovascular and Stryker Neurovascular and has research grants from the NIH, eV3/Covidien Neurovascular, Codman Neurovascular, Fraunhofer Institute, the Wyss Institute, Philips Healthcare, Stryker Neurovascular, Silk Road and Lazarus-Effect. PK consults for Stryker Neurovascular, Covidien and MicroVention. FC consults for Covidien and Codman Neurovascular.
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Puri, A.S., Massari, F., Asai, T. et al. Safety, efficacy, and short-term follow-up of the use of Pipeline™ Embolization Device in small (<2.5mm) cerebral vessels for aneurysm treatment: single institution experience. Neuroradiology 58, 267–275 (2016). https://doi.org/10.1007/s00234-015-1630-5
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DOI: https://doi.org/10.1007/s00234-015-1630-5