Failure of the Pipeline Embolization Device in Posterior Communicating Artery Aneurysms Associated with a Fetal Posterior Cerebral Artery

Abstract

The pipeline embolization device has emerged as an important endovascular option. This is in part due to safety, efficacy, and possibly the ability to shorten the operative time considerably. With this new technology, some limitations are emerging as experience accumulates. We report three cases of posterior communicating (PCOM) artery aneurysms associated with fetal posterior cerebral artery where pipeline embolization was unsuccessful in obliterating the aneurysms. PCOM artery aneurysms associated with a fetal PCA should be managed either by microsurgical clipping or coiling when feasible.

Factors Affecting the Obliteration Rate of Intracranial Aneurysms Treated with a Single Pipeline Embolization Device

“…The only predictive factor for aneurysm obliteration after treatment was the presence of an artery arising from neck of the aneurysm, which dramatically reduces the rate of complete aneurysmal obliteration. This is in contrast with previous studies 13,15 which showed a fetal PCA as the only predictor of failed aneurysm occlusion. Our study demonstrates that one PED is sufficient to induce occlusion or near-occlusion of most aneurysms, especially those without a branching artery from the aneurysm neck.…”

“…They described failed obliteration of these aneurysms due to the high flow and demand through the fetal PCA. 15 In contrast to Saatchi et al, the goal of the treatment in their series was obliteration of the aneurysm, and these aneurysms subsequently underwent surgical clipping. 21 Tsang et al reported similar obliteration rates for PCOM aneurysms with fetal PCA.…”

“…Aneurysms arising from a fetal origin of the PCA have been described as less favorable for treatment with the PED in terms of obliteration. 15 The objective of using Pipeline in these cases vary in the literature.…”

“…14 There are few studies evaluating the factors influencing aneurysm obliteration rate, and most of the previous reports did not isolate aneurysms treated with a single device compared to multiple devices. 13,15 …”

Comment on “Failure of the Pipeline Embolization Device in Posterior Communicating Artery Aneurysms Associated with a Fetal Posterior Cerebral Artery”

“…We read with interest the article by Zanaty et al “Failure of the Pipeline Embolization Device in Posterior Communicating Artery Aneurysms Associated with a Fetal Posterior Cerebral Artery” [1]. …”