Flow diverter for endovascular treatment of intracranial mirror segment internal carotid artery aneurysms
Department of Radiology; New England Center for Stroke Research
Cardiovascular Diseases | Cardiovascular System | Equipment and Supplies | Nervous System Diseases | Neurology | Radiology | Therapeutics
Background: To evaluate the feasibility and efficacy of the pipeline embolization device in the treatment of unruptured intracranial mirror segment aneurysms.
Methods: Out of a total of 338 subjects, 14 were identified harboring a total of 32 internal carotid artery mirror segment aneurysms that were treated with the pipeline embolization device and were consecutively enrolled into our study. We collected data on patient demographics, modified Rankin scale (mRS) at admission, aneurysm characteristics, clinical outcome at discharge, 3-9 and at 12-18 months as well as angiography results at follow-up.
Results: Patients' mean age was 52.9 years; baseline mRS was 0 in all subjects. Pipeline embolization device placement was successful in all cases. Post-treatment mRS remained 0 in 13/14 patients. One patient experienced a small intraparenchymal hemorrhage and subarachnoid hemorrhage, associated with a frontoparietal infarction resulting in right upper extremity weakness and aphasia (post-treatment mRS 3). His mRS evaluation remained stable at the 3-9-month follow-up. Three to 9-month follow-up angiography (13/14 subjects) showed complete aneurysm occlusion in 24/30 aneurysms (80%), near complete and partial occlusion in three of 30 (10%) aneurysms each. At the 9-month follow-up, one patient experienced a complete occlusion of the anterior temporal artery branch but did not present with any clinical deficits. No mRS changes were encountered over a median 6-month follow-up period. Mid-term follow-up angiography (12-18 months) available in eight of 14 subjects showed complete aneurysm occlusion in all patients. Mild intimal hyperplasia was observed in one patient.
Conclusions: Flow diversion technology can be used for the treatment of unruptured mirror segment aneurysms in selected patients.
Endovascular treatment, flow diverter, mirror segment aneurysms, pipeline embolization device
DOI of Published Version
Interv Neuroradiol. 2018 Aug 6:1591019918792536. doi: 10.1177/1591019918792536. [Epub ahead of print] Link to article on publisher's site
Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences
Kuhn AL, Kan P, Srinivasan V, Rex DE, de Macedo Rodrigues K, Howk M, Wakhloo AK, Puri AS. (2018). Flow diverter for endovascular treatment of intracranial mirror segment internal carotid artery aneurysms. Radiology Publications and Presentations. https://doi.org/10.1177/1591019918792536. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/422