Pipeline embolization of distal posterior inferior cerebellar artery aneurysms

Abstract

Background and purpose Flow diversion is commonly used to treat intracranial aneurysms in various regions of the cerebral vasculature, but is only approved for use in the internal carotid arteries. Treatment of distal PICA aneurysms with PED is sometimes performed but has not been well studied. Here, we report our experience with flow diversion of distal PICA aneurysms with PED. Materials and methods Clinical and angiographic data of eligible patients was retrospectively obtained and assessed for key demographic characteristics and clinical and angiographic outcomes. Principal outcomes included rates of aneurysm occlusion, ischemic or hemorrhagic complication, technical complication, and in-stent stenosis. Results Three female and 2 male patients underwent placement of PED in the PICA for treatment of 5 distal PICA aneurysms. Clinical and angiographic follow-up was obtained for all patients. Complete aneurysm occlusion was observed in 100% (5/5) of treated aneurysms at 6 month and longest angiographic follow-up. While there were no ischemic or device-related complications, delayed hemorrhagic complications occurred in 20% (1/5) of patients. Conclusion Pipeline embolization of distal PICA aneurysms can be performed in select patients. Further study is necessary in larger cohorts to better define clinical scenarios in which flow diversion in the distal PICA should be considered.

Safety and effect of pipeline flex embolization device for complex unruptured intracranial aneurysms

“…Instent or intravascular stenosis and restenosis may occur in the PED as well as in other intracranial stents used in treating intracranial vascular diseases 16 , 33 . The deployment of endovascular stents and flow diverters like the PED will result in de-endothelialization and subsequently a strong inflammatory cascade to cause neointimal hyperplasia.…”

“…For complex cerebral aneurysms like small, wide-necked, large, giant, dissecting, and fusiform aneurysms, the safety and clinical effect after treatment with the PED Flex device are unknown. Although some individualized studies have reported some short-term outcomes using the PED device in treating complex aneurysms 13 , 16 , not a single study has been reported to include most complex cerebral aneurysms in one study with the same group of physicians and similarly proficient endovascular embolization skills using the PED Flex device in a hospital with a large volume of patients. It was hypothesized that the PED Flex device acted well in treating complex intracranial aneurysms as the first-general PED device, and patients with complex aneurysms treated in a large-volume hospital by the same group of physicians with the same proficiency in endovascular embolization skills would greatly improve the treatment outcome and decrease the complication rate using the PED Flex device.…”

Flow Diversion for the Treatment of Posterior Inferior Cerebellar Aneurysms: A Novel Classification of Posterior Inferior Cerebellar Artery Origin

“…There are only 3 series with 7 proximal PICA aneurysms (the series were mostly comprised distal PICA aneurysms) that have reported this type of treatment to date in the literature. 9,11,23 Their results are promising, with 100% complete occlusion rates and without complications; however, additional studies with larger sample sizes are needed to determine its safety and feasibility, particularly in cases where there is less than 5 mm of proximal landing zone for the FD.…”

“…8 Initial experiences treating distal PICA aneurysms have been encouraging, motivating the development and use of smaller devices such as the Silk Vista Baby or the FRED Jr deployed in the PICA lumen. [9][10][11] Although safe and effective, FD use has not been shown to have conclusive results in treating proximal PICA aneurysms when deployed in the VA. 12,13 One of the controversies is that the PICA is an end-vessel without significant collaterals, which promotes gradient flow that may keep the IAs patent. 3 PICA origin in relation to the aneurysm and its impact with occlusion after FD has not been studied, which has been found to be important for aneurysms arising from other locations.…”

Endovascular treatment of distal cerebral aneurysms

“…Главными трудностями при эндоваскулярной эмболизации дистальных аневризм были и остаются усложненные навигация и стабилизация микрокатетера в полости аневризмы, а также использование ассистирующих методик [3,5,6,8,11,22]. Однако с появлением потокперенаправляющих стентов данные проблемы практически нивелированы [16,19,23].…”