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. 2019 Jul 1;131(1):32-39.
doi: 10.3171/2018.2.JNS172673. Epub 2018 Jul 13.

Proposal of a follow-up imaging strategy following Pipeline flow diversion treatment of intracranial aneurysms

Raghav Gupta  1 , Christopher S Ogilvy  1 , Justin M Moore  1 , Christoph J Griessenauer  1   2 , Alejandro Enriquez-Marulanda  1 , Madeline Leadon  1 , Nimer Adeeb  1 , Luis Ascanio  1 , Georgios A Maragkos  1 , Abhi Jain  2 , Philip G R Schmalz  1 , Abdulrahman Y Alturki  1 , Kimberly Kicielinski  1 , Clemens M Schirmer  2 , Ajith J Thomas  1
Affiliations

Proposal of a follow-up imaging strategy following Pipeline flow diversion treatment of intracranial aneurysms

Raghav Gupta et al. J Neurosurg. .

Abstract

Objective: There is currently no standardized follow-up imaging strategy for intracranial aneurysms treated with the Pipeline embolization device (PED). Here, the authors use follow-up imaging data for aneurysms treated with the PED to propose a standardizable follow-up imaging strategy.

Methods: A retrospective review of all patients who underwent treatment for ruptured or unruptured intracranial aneurysms with the PED between March 2013 and March 2017 at 2 major academic institutions in the US was performed.

Results: A total of 218 patients underwent treatment for 259 aneurysms with the PED and had undergone at least 1 follow-up imaging session to assess aneurysm occlusion status. There were 235 (90.7%) anterior and 24 posterior (9.3%) circulation aneurysms. On Kaplan-Meier analysis, the cumulative incidences of aneurysm occlusion at 6, 12, 18, and 24 months were 38.2%, 77.8%, 84.2%, and 85.1%, respectively. No differences in the cumulative incidence of aneurysm occlusion according to aneurysm location (p = 0.39) or aneurysm size (p = 0.81) were observed. A trend toward a decreased cumulative incidence of aneurysm occlusion in patients 70 years or older was observed (p = 0.088). No instances of aneurysm rupture after PED treatment or aneurysm recurrence after occlusion were noted. Sixteen (6.2%) aneurysms were re-treated with the PED; 11 of these had imaging follow-up data available, demonstrating occlusion in 3 (27.3%).

Conclusions: The authors propose a follow-up imaging strategy that incorporates 12-month digital subtraction angiography and 24-month MRA for patients younger than 70 years and single-session digital subtraction angiography at 12 months in patients 70 years or older. For recurrent or persistent aneurysms, re-treatment with the PED or use of an alternative treatment modality may be considered.

Keywords: DSA = digital subtraction angiography; ICA = internal carotid artery; PED = Pipeline embolization device; cerebrovascular; flow diversion; follow-up imaging; intracranial aneurysm; mRS = modified Rankin Scale; occlusion rate; rupture; vascular disorders.

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