Pipeline Embolization of Vertebrobasilar Aneurysms-A Multicenter Case Series.

Aneurysm Pipeline embolization Posterior circulation Vertebrobasilar

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
Apr 2019
Historique:
received: 25 06 2018
revised: 11 12 2018
accepted: 13 12 2018
medline: 6 1 2019
pubmed: 6 1 2019
entrez: 6 1 2019
Statut: ppublish

Résumé

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

Sections du résumé

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

Identifiants

DOI: 10.1016/j.wneu.2018.12.116 PMID: 30610980
pubmed: 30610980
pii: S1878-8750(18)32939-5
doi: 10.1016/j.wneu.2018.12.116
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e460-e469

Informations de copyright

Copyright © 2019 Elsevier Inc. All rights reserved.

Auteurs

Adam N Wallace (AN)

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.

Thomas P Madaelil (TP)

Department of Radiology, Emory University, Atlanta, Georgia, USA.

Mudassar Kamran (M)

Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA.

Timothy R Miller (TR)

Department of Radiology, University of Maryland, Baltimore, Maryland, USA.

Josser E Delgado Almandoz (JE)

Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.

Jonathan A Grossberg (JA)

Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.

Akash P Kansagra (AP)

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.

Dheeraj Gandhi (D)

Department of Radiology, University of Maryland, Baltimore, Maryland, USA.

Yasha Kayan (Y)

Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.

C Michael Cawley (CM)

Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.

Christopher J Moran (CJ)

Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA; Department of Neurosurgery, Washington University, St. Louis, Missouri, USA.

Gaurav Jindal (G)

Department of Neurology, University of Maryland, Baltimore, Maryland, USA; Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA.

Travis CreveCoeur (T)

Department of Neurosurgery, Washington University, St. Louis, Missouri, USA.

Brian M Howard (BM)

Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.

DeWitte T Cross (DT)

Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA; Department of Neurosurgery, Washington University, St. Louis, Missouri, USA.

Matthew J Kole (MJ)

Department of Neurosurgery, University of Maryland, Baltimore, Maryland, USA.

Anil K Roy (AK)

Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.

Jacques E Dion (JE)

Department of Radiology, Emory University, Atlanta, Georgia, USA.

Joshua W Osbun (JW)

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.

Classifications MeSH