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World Neurosurg. 2019 Jan 3. pii: S1878-8750(18)32939-5. doi: 10.1016/j.wneu.2018.12.116. [Epub ahead of print]

Pipeline Embolization of Vertebrobasilar Aneurysms-A Multicenter Case Series.

Author information

1
Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Department of Radiology, University of Iowa, Iowa City, Iowa, USA. Electronic address: adam.wallace@crlmed.com.
2
Department of Radiology, Emory University, Atlanta, Georgia, USA.
3
Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA.
4
Department of Radiology, University of Maryland, Baltimore, Maryland, USA.
5
Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
6
Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
7
Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA; Department of Neurosurgery, Washington University, St. Louis, Missouri, USA; Department of Neurology, Washington University, St. Louis, Missouri, USA.
8
Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA; Department of Neurosurgery, Washington University, St. Louis, Missouri, USA.
9
Department of Neurology, University of Maryland, Baltimore, Maryland, USA; Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA.
10
Department of Neurosurgery, Washington University, St. Louis, Missouri, USA.
11
Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA.
12
Department of Neurosurgery, Washington University, St. Louis, Missouri, USA; Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA; Department of Neurology, Washington University, St. Louis, Missouri, USA.

Abstract

BACKGROUND:

The Pipeline Embolization Device (PED) has been increasingly used for the treatment of posterior circulation aneurysms. The purpose of the present study was to examine the clinical and angiographic outcomes of patients with vertebrobasilar aneurysms treated with the PED.

METHODS:

We performed a retrospective review of vertebrobasilar aneurysms treated with the PED at 4 high-volume neurovascular centers. Patient, aneurysm, and procedural data were collected, including perioperative and delayed complications. Aneurysm occlusion on follow-up imaging studies was defined as complete (100%), near-complete (>90%), or incomplete (<90%) occlusion.

RESULTS:

The cohort included 35 patients with 37 vertebrobasilar aneurysms who underwent 36 treatment sessions. Of the 35 patients, 10 were men (29%), and the mean patient age was 54.1 years (range, 32-75). Eight patients (23%) underwent urgent treatment because of a ruptured aneurysm (n = 6), brainstem perforator stroke (n = 1), or post-traumatic pseudoaneurysm (n = 1). Of the 37 aneurysms, 22 arose from the vertebral artery (59%) and 15 from the basilar artery (41%). Also, 19 were saccular aneurysms (51%), with a mean size of 7.7 mm (range, 1.7-38.0); 17 were fusiform aneurysms (46%), with a mean size of 11.0 mm (range, 4.3-34); and 1 was a 2.9-mm blister aneurysm. The overall procedural complication rate was 14% (5 of 36), including 3 neurologically symptomatic complications. At a mean follow-up period of 14 months (range, 3-59), 24 of 34 aneurysms (71%) were completely occluded and 29 of 34 (85%) were completely or near-completely occluded.

CONCLUSION:

Our results show that Pipeline embolization of vertebrobasilar aneurysms is associated with acceptable occlusion and complication rates.

KEYWORDS:

Aneurysm; Pipeline embolization; Posterior circulation; Vertebrobasilar

PMID:
30610980
DOI:
10.1016/j.wneu.2018.12.116

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