E-009 endovascular treatment of complex distal posterior cerebral artery aneurysms with the pipeline embolization device

Abstract

Background Treatment of complex posterior circulation aneurysms can be extremely difficult and particularly challenging when the aneurysm is fusiform in nature or located within the distal segments of the cerebral vasculature. The Pipeline Embolization Device (PED) has become increasingly more popular for treatment of complex intracranial aneurysms, particularly within the anterior and proximal posterior circulation. No studies have examined the devices results in the treatment of distal posterior circulation aneurysms, including device patency within smaller distal vessels and aneurysm occlusion rates. Objective To retrospectively present our institutional experience with use of the PED in treatment of complex posterior cerebral artery aneurysms. Methods A total of 2 patients presenting with complex, distal posterior cerebral artery aneurysms were treated with the PED at our institution from November 2012 to March 2013. All patients medical records were reviewed including clinic visits, cross sectional imaging and angiographic studies. Results All patients had presented to our clinic with unruptured aneurysms. Both patients presented with a chief complaint of headache, in addition, patient 2 developed a progressive left-sided visual field deficit over the previous 6 weeks. The average size of the aneurysms was 8.0 mm at its largest diameter. Patient 1’s aneurysm was saccular in nature, measured 6 × 4 mm, arose for the right P2–3 junction and incorporated a posterolateral temporal branch at its base. Patient 2’s aneurysm was fusiform in morphology, partially thrombosed and arose from a dysplastic portion of the late-P2 segment at an early bifurcation of the posterior cerebral artery. Both patients underwent aneurysm embolization utilizing a single PED. Due to the morphology and junctional nature of patient 2’s partially thrombosed aneurysm, adjunctive intrasaccluar coils were placed prior to PED deployment. All patients achieved a favorable post-procedural outcome (mRS = 0). No patients experienced neurologic complications or perforator infarction from endovascular treatment from the PED. Presenting symptoms resolved in both patients, including complete resolution of patient 2’s progressive left-sided visual field deficit. Follow-up cerebral angiography at one year showed 100% aneurysm occlusion with no flow limiting stenosis of the PED. Conclusion Given the increased morbidity associated with microsurgery and the limitations of other treatment methods, PED use provides a practical and viable treatment option for distal posterior cerebral artery aneurysms. Based on our limited institutional experience, PED use for treatment of distal posterior cerebral artery aneurysms in select patients, is shown to be safe and effective. Disclosures P. Mazaris: None.