Endovascular treatment of intracraneal aneurysm with pipeline embolization device: experience in four centres in Barcelona

Abstract

Flow diverters represent a useful tool in the treatment of fusiform aneurysms and wide-neck saccular aneurysms which until the advent of this technology were problematic to treat. Pipeline™ Embolization Device (PED) has been described in several series showing high rates of occlusion and being relatively safe.

Objective: Shows the experience in four different neurointerventional centres in Barcelona with the PED (Covidien) between February 2010 and October 2013.

Methods: We reviewed retrospectively patients treated with PED in four neurointerventional centres in Barcelona between February 2010 and October 2013.

Results: Forty-two patients (89.4%) with non-ruptured aneurysms and five (10.6%) post-SAH were treated, with a mean age of 51 years (range 26-76). We treated 67 aneurysms with a mean of 1.4 1-3 PED per patient. We have no mortality and three post-procedural complications with clinical consequences, two of them severe with intracranial haemorrhage and the other with anterior choroidal artery thrombosis. Follow-up was in 45 patients (65 aneurysm) achieving complete occlusion in 90.8% at 12 months of follow-up. Two aneurysms which remained without any changes were distal and fusiform including main bifurcations (3.1%).

Conclusion: Treatment by PED of fusiform or wide-neck saccular aneurysms is associated with high rates of occlusion after six and 12 months. Correct selection of the patients, aneurysms and also specific characteristics of the Pipeline device should be known in order to select the best therapeutic option. Our findings suggest that the indication must be judged case by case in the selection of suitable patients for PED therapy.

Keywords: AAS: Aspirine; AHT: Arterial hypertension; Aneurysm; DM: Diabetes mellitus; EVP: Endovascular procedure; Embolization; FA: Fusiform aneurysm; FD: Flow diverter stent; Flow Diverter; ICA: Internal carotid artery; PED: Pipeline embolization device; SA: Saccular aneurysm; SAH: Subarachnoid haemorrhage; aPTT: Activated partial thromboplastin time; mRs: The modified Rankin scale.