Abstract
Background:The pipeline embolization device (PED) provides effective, durable and safe endovascular reconstruction of large and giant intracranial aneurysms. However, 80% of all cerebral aneurysms found in the general population are less than 10 mm in size. Treatment of small aneurysms (<10 mm) with flow diverters may be advantageous over endosaccular modalities that carry risks of procedural rupture during aneurysm access or coil placement.Methods:We retrospectively reviewed a prospective, single-center aneurysm database to identify all patients with small (<10 mm) internal carotid artery (ICA) aneurysms who underwent endovascular treatment using the PED. Patient demographics, aneurysm characteristics, procedural details, complications, and technical and clinical outcomes were analyzed.Results:Forty-four cases were performed in 41 patients (age range 31-78 years). PED was successfully implanted in 42 cases. A single PED was used in 37/42 (88%) cases. Mean postprocedure hospital stay was 1.7 ± 0.3 days and 98% of patients were discharged home. Major complication occurred in one patient (2.3%), who died of early subarachnoid hemorrhage. Transient neurological deficit, delayed intracerebral hemorrhage (asymptomatic), and delayed groin infection occurred in one patient each. Follow-up rate was 91.8% (45 aneurysms in 35 patients) with a mean follow-up of 4.0 ± 1.9 months. By 6 months post-PED implantation, angiographic success (complete or near complete aneurysm occlusion) was observed in 80%. Mild (<50%), asymptomatic, nonflow limiting in-stent stenosis was observed in 5.4% (2/37 cases). All the 35 patients with follow-up remained at preprocedure neurological baseline.Conclusion:Small (<10 mm) ICA aneurysm treatment with PED implantation is safe and carries a high rate of early angiographic success.
Highlights
Since its inception in 2007, flow‐diverting technology has revolutionized the treatment approach of large and giant cerebral aneurysms from an endosaccular to an endoluminal focus
Treatment of small aneurysms (
Patients presenting with severe headache and clinical suspicion for subarachnoid hemorrhage (SAH) were screened with a computed tomography (CT) scan of the head and, if necessary, lumbar puncture to rule out a hemorrhage event
Summary
Since its inception in 2007, flow‐diverting technology has revolutionized the treatment approach of large and giant cerebral aneurysms from an endosaccular to an endoluminal focus. This innovative strategy has enabled successful endovascular treatment of intracranial aneurysms previously considered difficult to treat with the conventional modalities of clipping and coiling with or without adjunctive devices (i.e., large, giant, wide‐necked, or with diffuse circumferential involvement of the parent artery).[6,11,18,19,21,30] The Pipeline embolization device (PED; Covidien Vascular Therapies, Mansfield, MA) is currently the only Food and Drug Administration (FDA)‐approved flow diverter available in the United States. Treatment of small aneurysms (
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