Abstract
Background: Intracranial dissecting aneurysms (IDAs) are rare but pose significant challenges to treatment. The pipeline embolization device (PED) has been demonstrated to be an effective treatment option with excellent outcomes. Herein, we report our experience with patients treated with the PED for unruptured IDAs.Methods: We retrospectively reviewed our hospital database and identified patients who were treated with PEDs for unruptured IDAs between March 2016 and September 2020. Data including demographics, clinical presentation, aneurysm characteristics, procedural details, intra- or peri-procedural complications, and follow-up details were collected.Results: Eighty patients (61 men, 76.25%) were treated with PED for unruptured IDAs. The most common symptoms were headache (34, 42.5%), dizziness (29, 36.25%), and nausea or vomiting (15, 18.75%). Of these patients, 73 had one aneurysm, and seven harbored two aneurysms. All of them achieved successful PED deployment. Six patients experienced intra- or peri-procedural complications including perforator artery occlusion, thromboembolic, hemorrhagic events, and falling of the stent into the aneurysm sac. Follow-up with digital subtractive angiography was available for 29 patients with a median of 6 months, and 28 (96.56%) patients had aneurysm occlusion. Late thrombosis occurred in four patients, and two of them had unfavorable outcomes. Clinical follow-up showed that a favorable clinical outcome was achieved in 76 (95%) patients, and the mortality rate was 3.75%.Conclusion: Treating unruptured IDAs is safe and effective with long-term favorable clinical and angiographic outcomes. However, the complications of this treatment should be noted. Careful selection of appropriate patients and individualized antiplatelet therapy might be needed.
Highlights
Intracranial dissecting aneurysms (IDAs) are uncommon types of cerebrovascular lesions caused by a disruption of the internal elastic lamina and account for only 3% of all intracranial aneurysms [1]
We present a retrospective analysis of the procedure-related complications, angiographic outcomes, and clinical outcomes for patients with unruptured IDAs who received pipeline embolization device (PED) treatment in a high-volume center
We reviewed our hospital database to identify consecutive patients who were admitted to our department for the treatment of unruptured IDAs between March 2016 and September 2020
Summary
Intracranial dissecting aneurysms (IDAs) are uncommon types of cerebrovascular lesions caused by a disruption of the internal elastic lamina and account for only 3% of all intracranial aneurysms [1] Even though they are less frequent than saccular aneurysms, IDAs have been recognized as an important source of subarachnoid hemorrhage (SAH) in children, young adults, and middle-aged adults, especially in the East Asian population [2, 3]. The risk of SAH has shifted treatment for unruptured IDAs away from initial conservative therapy toward more invasive approaches These lesions still pose a major challenge to endovascular treatment due to their unique location and anatomic characteristics [4, 5]. The PED can be used as an endoluminal reconstruction device that preserves the parent artery and major side branches These characteristics of a PED make it ideal for the treatment of IDAs. Intracranial dissecting aneurysms (IDAs) are rare but pose significant challenges to treatment. We report our experience with patients treated with the PED for unruptured IDAs
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