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Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device.

Publication ,  Journal Article
Monteith, SJ; Tsimpas, A; Dumont, AS; Tjoumakaris, S; Gonzalez, LF; Rosenwasser, RH; Jabbour, P
Published in: J Neurosurg
April 2014

OBJECT: Despite advances in surgical and endovascular techniques, fusiform aneurysms remain a therapeutic challenge. Introduction of flow-diverting stents has revolutionized the treatment of aneurysms with wide necks and of complex morphology. The authors report their experience with the endovascular treatment of fusiform aneurysms using the Pipeline Embolization Device. METHODS: A retrospective review of 146 patients with cerebral aneurysms treated with the Pipeline Embolization Device between June 2011 and January 2013 was performed. Twenty-four patients were identified as having fusiform aneurysms. Twenty-four aneurysms in these 24 patients were treated. The mean patient age was 59 years. There were 9 men and 15 women. Angiographic and clinical data (including the modified Rankin Scale [mRS] score) were recorded at the time of treatment and at follow-up. The aneurysms were located in the internal carotid artery in 8 patients (33.3%), middle cerebral artery in 8 patients (33.3%), anterior cerebral artery in 1 patient (4%), and vertebrobasilar circulation in 7 patients (29%). The aneurysms were smaller than 10 mm in 3 patients, 10-25 mm in 16 patients, and larger than 25 mm in 5 patients. The mean largest dimension diameter was 18 mm. RESULTS: Stent deployment was successful in all cases. The minor procedural morbidity was 4% (1 case). Morbidity and mortality related to aneurysm treatment were 4.2% and 4.2%, respectively. The mean mRS scores preoperatively and at clinical follow-up (median 6.0 months, mean 6.9 months) were 0.71 and 1.2, respectively (91.7% presented with an mRS score of 2 or better, and 79.2% had an mRS score of 2 or better at the 6.0-month follow-up). At clinical follow-up, 82.6% of patients were stable or had improved, 13.0% worsened, and 4.2% had died. Twenty-two (91.7%) of 24 patients had follow-up angiography available (mean follow-up time 6.3 months); 59% had excellent angiographic results (> 95% or complete occlusion), 31.8% had complete aneurysm occlusion, 27.3% had greater than 95% aneurysm occlusion, 18.2% had a moderate decrease in size (50%-95%), 4.5% had a minimal decrease in size (< 50%), 13.6% had not changed, and 4.5% had an increase in size. CONCLUSIONS: This series demonstrates that endovascular treatment of fusiform cerebral aneurysms with flow diversion was a safe and effective treatment. Procedural complications were low. Long-term morbidity and mortality rates were acceptable given the complex nature of these lesions.

Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

April 2014

Volume

120

Issue

4

Start / End Page

945 / 954

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Cerebral Artery
  • Middle Aged
  • Male
  • Intracranial Aneurysm
  • Humans
  • Female
  • Endovascular Procedures
 

Citation

APA
Chicago
ICMJE
MLA
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Monteith, S. J., Tsimpas, A., Dumont, A. S., Tjoumakaris, S., Gonzalez, L. F., Rosenwasser, R. H., & Jabbour, P. (2014). Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device. J Neurosurg, 120(4), 945–954. https://doi.org/10.3171/2013.12.JNS13945
Monteith, Stephen J., Asterios Tsimpas, Aaron S. Dumont, Stavropoula Tjoumakaris, L Fernando Gonzalez, Robert H. Rosenwasser, and Pascal Jabbour. “Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device.J Neurosurg 120, no. 4 (April 2014): 945–54. https://doi.org/10.3171/2013.12.JNS13945.
Monteith SJ, Tsimpas A, Dumont AS, Tjoumakaris S, Gonzalez LF, Rosenwasser RH, et al. Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device. J Neurosurg. 2014 Apr;120(4):945–54.
Monteith, Stephen J., et al. “Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device.J Neurosurg, vol. 120, no. 4, Apr. 2014, pp. 945–54. Pubmed, doi:10.3171/2013.12.JNS13945.
Monteith SJ, Tsimpas A, Dumont AS, Tjoumakaris S, Gonzalez LF, Rosenwasser RH, Jabbour P. Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device. J Neurosurg. 2014 Apr;120(4):945–954.

Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

April 2014

Volume

120

Issue

4

Start / End Page

945 / 954

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Cerebral Artery
  • Middle Aged
  • Male
  • Intracranial Aneurysm
  • Humans
  • Female
  • Endovascular Procedures