Endovascular Treatment of Large or Giant Basilar Artery Aneurysms Using the Pipeline Embolization Device: Complications and Outcomes

Abstract

BackgroundThis study aimed to investigate clinical and angiographic outcomes of Pipeline embolization device (PED) treatment of large or giant basilar artery (BA) aneurysms and examine associated factors.MethodsClinical and angiographic data of 29 patients (18 men, 11 women) with large or giant BA aneurysms were retrospectively examined. Mean age was 44.1 ± 21.2 years (range, 30–68). Mean aneurysm size was 22.2 ± 8.3 mm (range, 12.0–40.1).ResultsMean angiographic follow-up was 18.3 ± 3.4 months (range, 4.5–60). The rate of adequate aneurysmal occlusion (O'Kelly–Marotta grade C–D) was 87%. The overall complication rate was 44.8%; most complications (84.6%) occurred in the periprocedural period. Univariable comparison of patients who did and did not develop complications showed significant differences in aneurysm size (p < 0.01), intra-aneurysmal thrombus (p = 0.03), and mean number of PEDs used (p = 0.02). Aneurysm size (odds ratio, 1.4; p = 0.04) was an independent risk factor for periprocedural complications in multivariable analysis. Mean clinical follow-up was 23.5 ± 3.2 months (range, 0.1–65). Nine patients (31%) had a poor clinical outcome (modified Rankin scale score ≥3) at last follow-up, including 7 patients who died. Univariable comparisons between patients with favorable and unfavorable clinical outcomes showed that aneurysm size (p = 0.009) and intra-aneurysmal thrombus (p = 0.04) significantly differed between the groups. Multivariable analysis showed that aneurysm size (odds ratio, 1.1; p = 0.04) was an independent risk factor for poor clinical outcome.ConclusionPED treatment of large or giant BA aneurysms is effective and can achieve a satisfactory long-term occlusion rate. However, the treatment complications are not negligible. Aneurysm size is the strongest predictor of perioperative complications and poor clinical outcome.

Reconstructive endovascular treatment for basilar artery trunk aneurysms: complications and clinical and angiography outcomes

“…Aneurysm size was an important predictor of clinical outcome in this study. 8 In addition, hemorrhagic complications-rather than ischemic complications-were associated with poor clinical outcomes in this study. Although ischemic complications were more common, most such cases were mild or gradually recovered with satisfactory clinical outcomes after the administration of antiplatelet drugs during follow-up.…”

“…diversion is an attractive treatment for BTAs, but it is controversial and off-label. 8 As such, the best reconstructive EVT for BTAs…”

“…Reconstructive EVT techniques (simple coils, conventional stents with or without coils, and the stent-in-stent technique) may be more suitable for BTAs but are associated with substantial morbidity and mortality and a higher recurrence rate during follow-up 6 7. Flow diversion is an attractive treatment for BTAs, but it is controversial and off-label 8. As such, the best reconstructive EVT for BTAs has not yet been established.…”

Case report: Covered stent placement to treat delayed aneurysmal rupture after flow diverter-assisted coil embolization

“…Saccular aneurysms with aspect ratio >1.6 also have a higher risk of DAR ( 11 ). Intra-thrombus proteases may play a role in the delayed rupture of these aneurysms, as they are more likely to have intraluminal thrombus ( 4 , 9 , 13 – 15 ). In large or giant aneurysms, adjunctive coiling or placement of multiple FDs to achieve complete aneurysm thrombosis and early isolation from the circulation have been suggested because of the higher risk of delayed rupture ( 16 , 17 ).…”

Long-term outcomes and dynamic changes of in-stent stenosis after Pipeline embolization device treatment of intracranial aneurysms

“…To adequately cover the aneurysm, treatment requires the use of multiple PEDs with overlapping placement, as well as placement across vessels of different diameters. 28 These factors all increase the risk of long-term postoperative ISS. Interestingly, we found that a higher BMI was associated with decreased occurrence of ISS.…”