A2, M2, P2 aneurysms and beyond

Results of treatment with pipeline embolization device in 65 patients

Christopher T. Primiani, Zeguang Ren, Peter Kan, Ricardo Hanel, Vitor Mendes Pereira, Wai Man Lui, Nitin Goyal, Lucas Elijovich, Adam Arthur, David M. Hasan, Santiago Ortega-Gutierrez, Edgar A. Samaniego, Ajit S. Puri, Anna L. Kuhn, Kirill Orlov, Dmitry Kislitsin, Anton Gorbatykh, Muhammad Waqas, Elad I. Levy, Adnan H. Siddiqui & 1 others Maxim Mokin

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Intracranial aneurysms located in the distal vessels are rare and remain a challenge to treat through surgical or endovascular interventions. Objective: To describe a multicenter approach with flow diversion using the pipeline embolization device (PED) for treatment of distal intracranial aneurysms. Methods: Cases of distal intracranial aneurysms defined as starting on or beyond the A2 anterior cerebral artery, M2 middle cerebral artery, and P2 posterior cerebral artery segments were included in the final analysis. Results: 65 patients with distal aneurysms treated with the PED were analyzed. Median aneurysm size at the largest diameter was 7.0 mm, 60% were of a saccular morphology, and 9/65 (13.8%) patients presented in the setting of acute rupture. Angiographic follow-up data were available for 53 patients, with a median follow-up time of 6 months: 44/53 (83%) aneurysms showed complete obliteration, 7/53 (13.2%) showed reduced filling, and 2/53 (3%) showed persistent filling. There was no association between patient characteristics, including aneurysm size (P=0.36), parent vessel diameter (P=0.27), location (P=0.81), morphology (P=0.63), ruptured status on admission (P=0.57), or evidence of angiographic occlusion at the end of the embolization procedure (P=0.49). Clinical outcome data were available for 60/65 patients: 95% (57/60) had good clinical outcome (modified Rankin Scale score of 0-2) at 3 months. Conclusions: This large multicenter study of patients with A2, M2, and P2 distal aneurysms treated with the PED showed that flow diversion may be an effective treatment approach for this rare type of vascular pathology. The procedural compilation rate of 7.7% indicates the need for further studies as the flow diversion technology constantly evolves.

Original languageEnglish (US)
JournalJournal of neurointerventional surgery
DOIs
StateAccepted/In press - Jan 1 2019

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varespladib methyl
Aneurysm
Equipment and Supplies
Intracranial Aneurysm
Therapeutics
Posterior Cerebral Artery
Anterior Cerebral Artery
Middle Cerebral Artery
Multicenter Studies
Blood Vessels
Rupture
Pathology
Technology

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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A2, M2, P2 aneurysms and beyond : Results of treatment with pipeline embolization device in 65 patients. / Primiani, Christopher T.; Ren, Zeguang; Kan, Peter; Hanel, Ricardo; Pereira, Vitor Mendes; Lui, Wai Man; Goyal, Nitin; Elijovich, Lucas; Arthur, Adam; Hasan, David M.; Ortega-Gutierrez, Santiago; Samaniego, Edgar A.; Puri, Ajit S.; Kuhn, Anna L.; Orlov, Kirill; Kislitsin, Dmitry; Gorbatykh, Anton; Waqas, Muhammad; Levy, Elad I.; Siddiqui, Adnan H.; Mokin, Maxim.

In: Journal of neurointerventional surgery, 01.01.2019.

Research output: Contribution to journalArticle

Primiani, CT, Ren, Z, Kan, P, Hanel, R, Pereira, VM, Lui, WM, Goyal, N, Elijovich, L, Arthur, A, Hasan, DM, Ortega-Gutierrez, S, Samaniego, EA, Puri, AS, Kuhn, AL, Orlov, K, Kislitsin, D, Gorbatykh, A, Waqas, M, Levy, EI, Siddiqui, AH & Mokin, M 2019, 'A2, M2, P2 aneurysms and beyond: Results of treatment with pipeline embolization device in 65 patients', Journal of neurointerventional surgery. https://doi.org/10.1136/neurintsurg-2018-014631
Primiani, Christopher T. ; Ren, Zeguang ; Kan, Peter ; Hanel, Ricardo ; Pereira, Vitor Mendes ; Lui, Wai Man ; Goyal, Nitin ; Elijovich, Lucas ; Arthur, Adam ; Hasan, David M. ; Ortega-Gutierrez, Santiago ; Samaniego, Edgar A. ; Puri, Ajit S. ; Kuhn, Anna L. ; Orlov, Kirill ; Kislitsin, Dmitry ; Gorbatykh, Anton ; Waqas, Muhammad ; Levy, Elad I. ; Siddiqui, Adnan H. ; Mokin, Maxim. / A2, M2, P2 aneurysms and beyond : Results of treatment with pipeline embolization device in 65 patients. In: Journal of neurointerventional surgery. 2019.
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title = "A2, M2, P2 aneurysms and beyond: Results of treatment with pipeline embolization device in 65 patients",
abstract = "Background: Intracranial aneurysms located in the distal vessels are rare and remain a challenge to treat through surgical or endovascular interventions. Objective: To describe a multicenter approach with flow diversion using the pipeline embolization device (PED) for treatment of distal intracranial aneurysms. Methods: Cases of distal intracranial aneurysms defined as starting on or beyond the A2 anterior cerebral artery, M2 middle cerebral artery, and P2 posterior cerebral artery segments were included in the final analysis. Results: 65 patients with distal aneurysms treated with the PED were analyzed. Median aneurysm size at the largest diameter was 7.0 mm, 60{\%} were of a saccular morphology, and 9/65 (13.8{\%}) patients presented in the setting of acute rupture. Angiographic follow-up data were available for 53 patients, with a median follow-up time of 6 months: 44/53 (83{\%}) aneurysms showed complete obliteration, 7/53 (13.2{\%}) showed reduced filling, and 2/53 (3{\%}) showed persistent filling. There was no association between patient characteristics, including aneurysm size (P=0.36), parent vessel diameter (P=0.27), location (P=0.81), morphology (P=0.63), ruptured status on admission (P=0.57), or evidence of angiographic occlusion at the end of the embolization procedure (P=0.49). Clinical outcome data were available for 60/65 patients: 95{\%} (57/60) had good clinical outcome (modified Rankin Scale score of 0-2) at 3 months. Conclusions: This large multicenter study of patients with A2, M2, and P2 distal aneurysms treated with the PED showed that flow diversion may be an effective treatment approach for this rare type of vascular pathology. The procedural compilation rate of 7.7{\%} indicates the need for further studies as the flow diversion technology constantly evolves.",
author = "Primiani, {Christopher T.} and Zeguang Ren and Peter Kan and Ricardo Hanel and Pereira, {Vitor Mendes} and Lui, {Wai Man} and Nitin Goyal and Lucas Elijovich and Adam Arthur and Hasan, {David M.} and Santiago Ortega-Gutierrez and Samaniego, {Edgar A.} and Puri, {Ajit S.} and Kuhn, {Anna L.} and Kirill Orlov and Dmitry Kislitsin and Anton Gorbatykh and Muhammad Waqas and Levy, {Elad I.} and Siddiqui, {Adnan H.} and Maxim Mokin",
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TY - JOUR

T1 - A2, M2, P2 aneurysms and beyond

T2 - Results of treatment with pipeline embolization device in 65 patients

AU - Primiani, Christopher T.

AU - Ren, Zeguang

AU - Kan, Peter

AU - Hanel, Ricardo

AU - Pereira, Vitor Mendes

AU - Lui, Wai Man

AU - Goyal, Nitin

AU - Elijovich, Lucas

AU - Arthur, Adam

AU - Hasan, David M.

AU - Ortega-Gutierrez, Santiago

AU - Samaniego, Edgar A.

AU - Puri, Ajit S.

AU - Kuhn, Anna L.

AU - Orlov, Kirill

AU - Kislitsin, Dmitry

AU - Gorbatykh, Anton

AU - Waqas, Muhammad

AU - Levy, Elad I.

AU - Siddiqui, Adnan H.

AU - Mokin, Maxim

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Intracranial aneurysms located in the distal vessels are rare and remain a challenge to treat through surgical or endovascular interventions. Objective: To describe a multicenter approach with flow diversion using the pipeline embolization device (PED) for treatment of distal intracranial aneurysms. Methods: Cases of distal intracranial aneurysms defined as starting on or beyond the A2 anterior cerebral artery, M2 middle cerebral artery, and P2 posterior cerebral artery segments were included in the final analysis. Results: 65 patients with distal aneurysms treated with the PED were analyzed. Median aneurysm size at the largest diameter was 7.0 mm, 60% were of a saccular morphology, and 9/65 (13.8%) patients presented in the setting of acute rupture. Angiographic follow-up data were available for 53 patients, with a median follow-up time of 6 months: 44/53 (83%) aneurysms showed complete obliteration, 7/53 (13.2%) showed reduced filling, and 2/53 (3%) showed persistent filling. There was no association between patient characteristics, including aneurysm size (P=0.36), parent vessel diameter (P=0.27), location (P=0.81), morphology (P=0.63), ruptured status on admission (P=0.57), or evidence of angiographic occlusion at the end of the embolization procedure (P=0.49). Clinical outcome data were available for 60/65 patients: 95% (57/60) had good clinical outcome (modified Rankin Scale score of 0-2) at 3 months. Conclusions: This large multicenter study of patients with A2, M2, and P2 distal aneurysms treated with the PED showed that flow diversion may be an effective treatment approach for this rare type of vascular pathology. The procedural compilation rate of 7.7% indicates the need for further studies as the flow diversion technology constantly evolves.

AB - Background: Intracranial aneurysms located in the distal vessels are rare and remain a challenge to treat through surgical or endovascular interventions. Objective: To describe a multicenter approach with flow diversion using the pipeline embolization device (PED) for treatment of distal intracranial aneurysms. Methods: Cases of distal intracranial aneurysms defined as starting on or beyond the A2 anterior cerebral artery, M2 middle cerebral artery, and P2 posterior cerebral artery segments were included in the final analysis. Results: 65 patients with distal aneurysms treated with the PED were analyzed. Median aneurysm size at the largest diameter was 7.0 mm, 60% were of a saccular morphology, and 9/65 (13.8%) patients presented in the setting of acute rupture. Angiographic follow-up data were available for 53 patients, with a median follow-up time of 6 months: 44/53 (83%) aneurysms showed complete obliteration, 7/53 (13.2%) showed reduced filling, and 2/53 (3%) showed persistent filling. There was no association between patient characteristics, including aneurysm size (P=0.36), parent vessel diameter (P=0.27), location (P=0.81), morphology (P=0.63), ruptured status on admission (P=0.57), or evidence of angiographic occlusion at the end of the embolization procedure (P=0.49). Clinical outcome data were available for 60/65 patients: 95% (57/60) had good clinical outcome (modified Rankin Scale score of 0-2) at 3 months. Conclusions: This large multicenter study of patients with A2, M2, and P2 distal aneurysms treated with the PED showed that flow diversion may be an effective treatment approach for this rare type of vascular pathology. The procedural compilation rate of 7.7% indicates the need for further studies as the flow diversion technology constantly evolves.

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U2 - 10.1136/neurintsurg-2018-014631

DO - 10.1136/neurintsurg-2018-014631

M3 - Article

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

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