Reduced Efficacy of the Pipeline Embolization Device in the Treatment of Posterior Communicating Region Aneurysms with Fetal Posterior Cerebral Artery Configuration

Roy, Anil K.; Howard, Brian M.; Haussen, Diogo C; Osbun, Joshua W.; Halani, Sameer H.; Skukalek, Susana L; Tong, Frank; Nogueira, Raul G; Dion, Jacques E.; Cawley, C. Michael; Grossberg, Jonathan A

doi:10.1093/neuros/nyx293

Cited by 35 publications

(29 citation statements)

References 18 publications

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“…Moreover, a lower rate of complete occlusion was observed in PcoA aneurysms coupled with fetal (vs non-fetal) types of PCA (66.7% vs 87.5%), although group differences were not significant (p=0.3) 26. Anil et al also found flow diversion less effective in occluding aneurysms with PcoA origins and fetal-type PCAs, citing fetal-type PCA as an independent risk factor (OR 73.65, 95% CI 5.84 to 929.13; p=0.001),27 and Adam et al achieved complete occlusion at a rate of only 33% after Pipeline embolization of PcoA aneurysms with fetal-type PCAs 28. Hence, fetal-type PCA seems to impact PcoA flow under these circumstances, limiting the occlusive potential of flow diversion.…”

Section: Discussionmentioning

confidence: 97%

Impact of fetal-type posterior cerebral artery on recanalization of posterior communicating artery aneurysms after coil embolization: matched-pair case–control study

Choi

Cho

Yoo

et al. 2020

J NeuroIntervent Surg

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BackgroundIt is well known that hemodynamic stress may impact the recanalization of coiled aneurysms. One of the most common sites for aneurysms to develop is the posterior communicating artery (PcoA), the variants of which are defined by diameter ratios (PcoA/P1 segment).ObjectiveThis study was undertaken to investigate the impact of a fetal-type posterior cerebral artery (PCA) on recanalization of PcoA aneurysms after coil embolization based on matched-pair (fetal vs non-fetal PCA) analysis.MethodsA total of 480 consecutive PcoA aneurysms (PCA: fetal, n=156; non-fetal, n=324) subjected to coil embolization between January 2007 and June 2017 were selected for study. All lesions were followed for ≥6 months via radiologic imaging, grouped by adjacent PCAs as fetal (PcoA/P1 >1) or non-fetal (PcoA/P1 ≤1) type. Paired subjects were matched (1:1) for several relevant variables.ResultsOf the 480 coiled aneurysms, 159 (33.1%) showed recanalization (minor, 76; major, 83) in the course of follow-up (mean 33.8±21.9 months), developing significantly more often in fetal (37.8%) than in non-fetal (26.9%; p=0.020) PCA types. Once matched, however, 6-month and cumulative recanalization rates did not differ significantly by group (p=0.531 and p=0.568, respectively). Complications (hemorrhage, p=0.97; thromboembolism, p=0.94) during endovascular coil embolization also showed similar rates in these groups.ConclusionsThe chances of recanalization after coil embolization seem to be greater in PcoA aneurysms than in intracranial aneurysms overall, thus calling for careful follow-up monitoring. Surprisingly, PcoA type appeared unrelated in this regard.

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Section: Discussionmentioning

confidence: 97%

Impact of fetal-type posterior cerebral artery on recanalization of posterior communicating artery aneurysms after coil embolization: matched-pair case–control study

Choi

Cho

Yoo

et al. 2020

J NeuroIntervent Surg

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“…35 However, PED treatment of aneurysms incorporating the origin of a fetal PCA was largely ineffective, probably because the fetal PCA has low compensation capabilities and the residual pressure gradient might prevent the aneurysm from occluding. 36,37 Actually, flow diversion of aneurysms incorporating a fetal PCA should only be considered when conventional treatments are unfeasible. 37…”

Section: Bifurcation Aneurysmsmentioning

confidence: 99%

“…36,37 Actually, flow diversion of aneurysms incorporating a fetal PCA should only be considered when conventional treatments are unfeasible. 37…”

Section: Bifurcation Aneurysmsmentioning

confidence: 99%

Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas

et al. 2019

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Flow diverter devices have gained wide acceptance for the treatment of unruptured intracranial aneurysms. Most studies are based on the treatment of large aneurysms harboring on the carotid syphon. However, during the last years the “off-label” use of these stents has widely grown up even if not supported by randomized studies. This review examines the relevant literature concerning “off-label” indications for flow diverter devices, such as for distal aneurysms, bifurcation aneurysms, small aneurysms, recurrent aneurysms, and direct carotid cavernous fistulas.

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“…But endovascular treatment of fetal PComA faces some challenges, specifically for the ruptured ones. Roy et al reported an independent association between incomplete occlusion and fPCA configuration [25]. Wallace et al reported a complication rate of 14% and overall complete occlusion rate of 33% [26].…”

Section: Discussionmentioning

confidence: 99%

Clinical features and outcomes of PComA aneurysms originating from fetal posterior communicating arteries in a single institution

Chen

Wang

et al. 2020

Chin Neurosurg Jl

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Background: The aim of this study was to retrospectively analyze our experience with the patients who underwent surgical treatment of posterior communicating artery (PComA) aneurysms originating from fetal posterior cerebral artery (fPCA) and analyze the risk factors for the postoperative radiological infarction and outcome. Methods: From 2011 to 2020, we retrospectively reviewed 74 PComA aneurysms originating from fPCA in terms of the clinical and radiological features and obtained the follow-up data from the

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Reduced Efficacy of the Pipeline Embolization Device in the Treatment of Posterior Communicating Region Aneurysms with Fetal Posterior Cerebral Artery Configuration

Abstract: The PED is a safe and effective treatment for PcommA aneurysms, although fetal anatomy should increase consideration of traditional endovascular techniques or surgical clipping.

Cited by 35 publications

References 18 publications

Impact of fetal-type posterior cerebral artery on recanalization of posterior communicating artery aneurysms after coil embolization: matched-pair case–control study

Impact of fetal-type posterior cerebral artery on recanalization of posterior communicating artery aneurysms after coil embolization: matched-pair case–control study

Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas

Clinical features and outcomes of PComA aneurysms originating from fetal posterior communicating arteries in a single institution

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