Patency of the posterior communicating artery following treatment with the Pipeline Embolization Device

Abstract

OBJECTIVE The Pipeline Embolization Device (PED) has become an effective treatment strategy for some cerebral aneurysms. Concerns regarding the patency of branch arteries have been raised. The objective of this study was to assess the patency of the posterior communicating artery (PCoA) following treatment of PCoA aneurysms using the PED. METHODS All patients with PCoA aneurysms treated with the PED who had angiographic follow-up were retrospectively identified. The patency of the PCoA at follow-up was evaluated by 2 authors who were not involved in the intervention. Univariate and multivariate analyses were performed to identify factors associated with the following: 1) PCoA patency versus no or diminished flow, and 2) PCoA patency and diminished flow versus PCoA occlusion. RESULTS Thirty patients with an angiographic follow-up of 6 months were included. Aneurysm obliteration was achieved in 25 patients (83.3%). The PCoA was patent in 7 patients (23.3%), had diminished flow in 7 patients (23.3%), and was occluded in 16 patients (53.3%). In the univariate analysis of outcome, there was a trend for aneurysms with incomplete occlusion, aneurysms not previously treated, those with presence of a fetal PCoA, and those with an artery coming from the aneurysm to have higher odds of the PCoA remaining patent. In univariate and multivariate analyses of factors associated with outcome, fetal PCoA and presence of an artery coming from the aneurysm were associated with the PCoA remaining open with or without diminished flow. No patients had symptoms related to PCoA occlusion. CONCLUSIONS Occlusion and diminished flow through the PCoA is common following PED treatment of PCoA aneurysms. However, it is clinically insignificant in most cases.

Flow diversion for anterior choroidal artery (AChA) aneurysms: a multi-institutional experience

“…Raz et al 31 described a single case of AChA coverage leading to asymptomatic occlusion for a PCoA aneurysm. FD for PCoA aneurysms resulted in occlusion of the vessel in approximately half of cases,32 with the fate of the remaining PCoAs evenly divided between diminished flow and complete patency (similar to our findings).…”

Long-Term Clinical and Angiographic Outcomes Following Pipeline Embolization Device Treatment of Complex Internal Carotid Artery Aneurysms: Five-Year Results of the Pipeline for Uncoilable or Failed Aneurysms Trial

“…18 Reported occlusion rates of the posterior communicating artery are more widely variable due to variability in the anatomy of the posterior communicating artery. [32][33][34][35][36][37] Factors likely associated with sidebranch occlusion include the number of PEDs covering the branch, the flow demand on that branch, and potential collateral circulation.…”

Tourniquet parent artery occlusion after flow diversion

“…This paradigm shift in wide application has been supported by large series showing relative safety of the PED. Despite initial concerns over the occlusion of branch vessels such as the ophthalmic artery and anterior choroidal artery, multiple studies have shown that these are largely well tolerated 6 12 13. As our experience with flow diversion with the PED and other devices grows, we are developing a nuanced understanding of the appropriate applications and potential outcomes.…”