Pipeline embolization of proximal middle cerebral artery aneurysms: A multicenter cohort study

Abstract

Background and purpose: Flow diversion of aneurysms located in the M1 segment and middle cerebral artery bifurcation with Pipeline embolization device is sometimes performed, but further study is needed to support its regular use in aneurysm treatment. Here, we report measures of safety and efficacy for Pipeline embolization in the proximal middle cerebral artery in a multi-center cohort.

Materials and methods: Clinical and angiographic data of eligible patients were retrospectively obtained from participating centers and assessed for key clinical and angiographic outcomes. Additional details were extracted for patients with complications.

Results: In our multi-center cohort, complete aneurysm occlusion was achieved in 71% (17/24) of treated aneurysms. There were no deaths or disabling strokes, but non-disabling ischemic strokes occurred in 8% (2/24) of patients. For aneurysms in the M1 segment, complete aneurysm occlusion was observed in 75% (12/16) of aneurysms, aneurysm volume reduction was observed in 100% (16/16) of aneurysms, and non-disabling ischemic strokes occurred in 13% (2/16) of patients. For aneurysms at the middle cerebral artery bifurcation, complete aneurysm occlusion was observed in 63% (5/8) of aneurysms, aneurysm volume reduction occurred in 88% (7/8) of aneurysms, and ischemic or hemorrhagic complications occurred in 0% (0/8) of patients.

Conclusion: Pipeline embolization of cerebral aneurysms in the M1 segment and middle cerebral artery bifurcation demonstrated a 71% rate of complete aneurysm occlusion. There were no deaths or disabling strokes, but there was an 8% rate of non-disabling ischemic strokes.

Keywords: Middle cerebral artery; aneurysm; endovascular; pipeline embolization device.

Figure 1.

Angiographic images in Patient 9. (a) Pre-treatment angiography and (b) pre-treatment 3 D reconstruction show a 13.4 × 12.0 mm aneurysm of the right M1 segment. (c) Immediate post-treatment angiography following deployment of 3.25 × 14 mm PED showing contrast stasis within the aneurysm. (d) 32-month follow-up angiography demonstrates complete occlusion of the aneurysm.