Abstract 176: Largest United States Pipeline Case Series After PUFS: Feasability, Technique, and Complications

Abstract

Largest US Pipeline Case Series After PUFS: Feasability, Technique, and Complications Object: Endovascular coil embolization is an established method of treatment for intracranial aneurysms. Incomplete occlusion and recanalization are potential pitfalls of this treatment, particularly in large, complex aneurysms. The pipeline embolization device(PED) is a low-porosity endovascular stent designed to reconstruct the parent artery and prohibit blood flow into the aneurysm. The resulting stasis in the aneurysm, which leads to thrombosis, and the subsequent endothelial incorporation of the stent is meant to provide curative protection from aneurysmal rupture. Following the FDA approval of the PED, the authors report the first case series of 25 patients who have undergone such embolization and examine feasibility, technique, early results, and complications. Methods: Twenty-five patients underwent PED placement for aneurysm at Jefferson Hospital for Neuroscience from October 2010 to July 2011. Clinical charts were reviewed for demographics, details of presentation, procedure, hospital course, and outcome. Results: Twenty-five patients with 31 aneurysms were treated in the series(2 male; 23 female; ages 34-82; mean age 60.9 years). All of the aneurysms were located in segments of the internal carotid artery(1 petrous, 1 lacerum, 13 cavernous, 2 clinoid, 12 ophthalmic, 2 superior hypophyseal). Patients presented with headache, cranial nerve palsy, TIA, recurrence, or as incidental findings. Four of the patients presented with recurrence after coil embolization; one patient was treated with PED after attempted coil embolization; one was treated for recurrence after prior PED placement. PED placement was successful in all patients. The number of stents used per patient ranged from 1 to 5, with most patients being treated with 1(n=6) or 2(n=13) PEDs. One aneurysm was treated with both PED and coil embolization. A postoperative complication or combination of complications were witnessed in 20%(n=5) of patients. These complications included intracerebral hemorrhage(n=3), dissection(n=1), stroke(n=2), and death(n=1). Follow-up angiograms have been performed for five patients, on average 31 days after embolization, with 1 of those 5 patients suffering from incomplete aneurysmal occlusion. Conclusion: This is the largest reported case series in the United States following the PUFS trial. Treatment of simple or complex intracranial aneurysms with PEDs alone or in conjunction with coil embolization is technically feasible with low chance of intraoperative complication. However, major perioperative adverse events must be studied. Respect for the indications of the procedure is crucial to justify the risk.