Remodeling of the Posterior Cerebral Artery P1-Segment after Pipeline Flow Diverter Treatment of Posterior Communicating Artery Aneurysms.

Miguel S Litao,Omar Tanweer,Peter K Nelson,Jan-Karl Burkhardt,Howard Riina,Maksim Shapiro,Paul Huang,Tibor Becske,Eytan Raz

doi:10.3390/neurolint13020020

Abstract

Introduction: Flow diverters such as the pipeline embolization device (PED) cause hemodynamic changes of the treated vessel segment. In posterior communicating artery (PcomA), aneurysms’ unique anatomic consideration have to be taken in account due to the connection between the anterior and posterior circulation. We hypothesize that in conjunction with PcomA remodeling, there will also be remodeling of the ipsilateral P1 segment of the posterior cerebral artery (PCA) after PED treatment for PcomA aneurysms. Methods: We retrospectively collected radiological as well as clinical data of PcomA aneurysm patients treated with PED including PcomA and P1 vessel diameters before and after treatment as well as patient and aneurysm characteristics. Results: Overall, 14 PcomA aneurysm patients were included for analysis and PED treatment was performed without complications in all patients. In 10 out of 14 patients (71%), a decrease in PcomA diameter was observed and there was a significant mean decrease of 0.78 mm in PcomA diameter on angiographic last follow-up (LFU) (p = 0.003). In the same patient population (10 out of 14 patients), there was meanwhile a significant mean increase of 0.43 mm in the ipsilateral P1 segment diameter observed (p = 0.015). These vessel remodeling effects were in direct correlation with aneurysm occlusion since all of these patients showed aneurysm occlusion at LFU while 29% showed only partial occlusion without vessel remodeling effects. A decrease in PcomA diameter was directly associated with aneurysm occlusion (p = 0.042). There were no neurologic complications on LFU. Conclusion: In the treatment of PcomA aneurysms with PED, the P1 segment of the PCA increases in diameter while the PcomA diameter decreases. Our results suggest that this remodeling effect is associated with aneurysm occlusion and decrease of PcomA is hemodynamically compensated for by an increase in the ipsilateral P1 diameter.

Highlights

Flow diverters such as the pipeline embolization device (PED) cause hemodynamic changes of the treated vessel segment
15 posterior communicating artery (PcomA) aneurysms in 14 patients were treated with the PED and included in this analysis
One patient was excluded as a Neuroform stent (Stryker Neurovascular; Fremont, CA), was placed in a fetal PcomA before PED treatment, thereby potentially limiting or confounding vessel remodeling

Summary

Introduction

Flow diverters such as the pipeline embolization device (PED) cause hemodynamic changes of the treated vessel segment. We hypothesize that in conjunction with PcomA remodeling, there will be remodeling of the ipsilateral P1 segment of the posterior cerebral artery (PCA) after PED treatment for PcomA aneurysms. Our results suggest that this remodeling effect is associated with aneurysm occlusion and decrease of PcomA is hemodynamically compensated for by an increase in the ipsilateral P1 diameter. The anatomic variety of the PcomA and its relationship to the ipsilateral P1 segment of the posterior cerebral artery (PCA) further complicates standardized selection for PED treatment [5,8]. We hypothesize that the resultant anatomic changes in the PcomA that accompany flow diverter origin coverage may lead to anatomic changes in the P1 segment given the putative hemodynamic balance between the two vessels to preserve sufficient blood supply in the posterior circulation

Methods

Results

Discussion

Conclusion