Efficacy analysis of Pipeline embolization device for the treatment of large or giant intracranial carotid aneurysms

Abstract

Objective To investigate the safety and efficacy of Pipeline embolization device (PED) in the treatment of large or giant intracranial carotid aneurysms. Methods A retrospective analysis was conducted on the clinical data of 12 consecutive patients with 13 intracranial carotid aneurysms who were treated with PED at Department of Neurosurgery, Sichuan Provincial People's Hospital from September 2015 to June 2016. Among them, 11 patients had 1 aneurysm and 1 had multiple aneurysms. The diameters of 13 aneurysms were 11.5-28.0 mm (18.6±5.1 mm). The aneurysm neck in all patients was manipulated with 1 PED, and 6 out of them were combined with coil embolization. Results The Pipelines were successfully implanted in 12 patients with 13 aneurysms. Among them, PED was implanted in 7 aneurysms and PED combined with coil embolization was applied in 6. No procedure-related complications occurred during follow-up which demonstrated symptomatic relief in all cases. The angiography immediately after PED implantation showed Raymond grade Ⅱ in 4 aneurysms and grade Ⅲ in 9. Imaging follow-up was conducted for 10 patients at 6-12 months post surgery. MRA was performed in 2 patients 6 months and indicated no residual arterial aneurysm and remote patency. Eight patients with 9 aneurysms underwent DSA showing no relapse of arterial aneurysm. Based on the modified Rankin scale (mRS), the scores at discharge were 0 in 2 cases and 1 in 10 and the scores at last follow-up were 0 in 9 cases and 1 in 3. There was no disability or death reported in this series. Conclusions PED is safe and effective in the treatment of large and giant intracranial carotid aneurysms. The long-term efficacy remains to be confirmed by large-scale studies with longer follow-up. Key words: Intracranial aneurysm; Cerebral revascularization; Treatment outcome; Pipeline embolization device