Flow Diversion for Treatment of Intracranial Aneurysms in Pediatric Patients: Multicenter Case Series
Department of Radiology
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Cardiovascular Diseases | Nervous System Diseases | Neurology | Pediatrics | Radiology | Surgery
BACKGROUND: Though the Pipeline Embolization Device (Medtronic) is approved for use in adults 22 yr and older, the high efficacy and long-term durability of the device is attractive for treatment of intracranial aneurysms in younger patients who often have aneurysms less amenable to traditional endovascular treatments.
OBJECTIVE: To report technical, angiographic, and clinical outcomes in patients aged 21 or below undergoing flow-diversion treatment for intracranial aneurysms.
METHODS: Retrospective review across 16 institutions identified 39 patients aged 21 or below undergoing 46 treatment sessions with Pipeline Embolization Device placement between 2012 and 2018. A total of 50 intracranial aneurysms were treated. Details regarding patient demographics, aneurysm characteristics, treatment considerations, clinical outcomes, and aneurysm occlusion were obtained and analyzed in a multicenter database.
RESULTS: A total of 70% of patients were male. Nonsaccular morphology was seen in half of identified aneurysms. Six aneurysms were giant, and five patients were treated acutely after ruptured presentation. Eight patients were younger than 10 yr of age. Complete aneurysm occlusion was seen in 74% of treated aneurysms. Three aneurysms (6%) were retreated. A total of 83% of patients had a modified Rankin Scale scores of < /=2 at last clinical follow-up. There were 2 early mortalities (4.3%) in the immediate postprocedure period because of rerupture of a treated ruptured aneurysm. No recanalization of a previously occluded aneurysm was observed.
CONCLUSION: Flow-diversion treatment is a safe and effective treatment for intracranial aneurysms in patients younger than 22 yr. Rates of complete aneurysm occlusion and adverse events are comparable for rates seen in older patients.
Flow diversion, Intracranial aneurysm, Pediatric, angiogram, intracranial aneurysm, aneurysm, ruptured aneurysm, follow-up, pediatrics, rupture devices, medical, diversion procedure, endovascular procedures, fluid flow
DOI of Published Version
Neurosurgery. 2019 Sep 26. pii: nyz380. doi: 10.1093/neuros/nyz380. [Epub ahead of print] Link to article on publisher's site
Cherian J, Puri AS, Kan P. (2019). Flow Diversion for Treatment of Intracranial Aneurysms in Pediatric Patients: Multicenter Case Series. Radiology Publications and Presentations. https://doi.org/10.1093/neuros/nyz380. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/504