Pipeline Embolization of Proximal Middle Cerebral Artery Aneurysms: A Multicenter Cohort Study

Overview

Journal Interv Neuroradiol

Publisher Sage Publications

Specialty Neurology

Date 2021 May 6

PMID 33951971

Citations 6

Authors

David C Lauzier

Brandon K Root

Yasha Kayan

Josser E Delgado Almandoz

Joshua W Osbun

Arindam R Chatterjee

Kayla L Whaley

Megan E Tipps

Christopher J Moran

Akash P Kansagra

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Flow diversion of aneurysms located in the M1 segment and middle cerebral artery bifurcation with Pipeline embolization device is sometimes performed, but further study is needed to support its regular use in aneurysm treatment. Here, we report measures of safety and efficacy for Pipeline embolization in the proximal middle cerebral artery in a multi-center cohort.

Materials And Methods: Clinical and angiographic data of eligible patients were retrospectively obtained from participating centers and assessed for key clinical and angiographic outcomes. Additional details were extracted for patients with complications.

Results: In our multi-center cohort, complete aneurysm occlusion was achieved in 71% (17/24) of treated aneurysms. There were no deaths or disabling strokes, but non-disabling ischemic strokes occurred in 8% (2/24) of patients. For aneurysms in the M1 segment, complete aneurysm occlusion was observed in 75% (12/16) of aneurysms, aneurysm volume reduction was observed in 100% (16/16) of aneurysms, and non-disabling ischemic strokes occurred in 13% (2/16) of patients. For aneurysms at the middle cerebral artery bifurcation, complete aneurysm occlusion was observed in 63% (5/8) of aneurysms, aneurysm volume reduction occurred in 88% (7/8) of aneurysms, and ischemic or hemorrhagic complications occurred in 0% (0/8) of patients.

Conclusion: Pipeline embolization of cerebral aneurysms in the M1 segment and middle cerebral artery bifurcation demonstrated a 71% rate of complete aneurysm occlusion. There were no deaths or disabling strokes, but there was an 8% rate of non-disabling ischemic strokes.

Citing Articles

Managing thrombosis risk in flow diversion: A review of antiplatelet approaches.

Toma A, Essibayi M, Osama M, Karandish A, Dmytriw A, Altschul D Neuroradiol J. 2025; 19714009251313515.

PMID: 39772903 PMC: 11707768. DOI: 10.1177/19714009251313515.

Pipeline versus non-pipeline flow diverter treatment for M1 aneurysms: A systematic review and meta-analysis.

Senol Y, Orscelik A, Bilgin C, Kobeissi H, Ghozy S, Arul S Neuroradiol J. 2024; :19714009241260805.

PMID: 39033417 PMC: 11571521. DOI: 10.1177/19714009241260805.

Flow diversion for unruptured fusiform aneurysms of the proximal middle cerebral artery.

Gai Y, Nuerdong M, Jiang Y, Wang W, Pu B, Xu F Front Neurol. 2024; 14:1325983.

PMID: 38192574 PMC: 10773848. DOI: 10.3389/fneur.2023.1325983.

Endovascular treatment of middle cerebral artery aneurysms: current status and future prospects.

Zhou Z, Lan W, Yu J Front Neurol. 2023; 14:1239199.

PMID: 38033773 PMC: 10684741. DOI: 10.3389/fneur.2023.1239199.

Long-term outcomes following pipeline embolization of unruptured aneurysms.

Naylor R, Abbasi M, Brinjikji W, Cloft H, Kallmes D, Lanzino G Acta Neurochir (Wien). 2023; 165(7):1891-1897.

PMID: 37191722 DOI: 10.1007/s00701-023-05619-1.

References

Kalaria R . The pathology and pathophysiology of vascular dementia. Neuropharmacology. 2017; 134(Pt B):226-239. DOI: 10.1016/j.neuropharm.2017.12.030. View

Caroff J, Neki H, Mihalea C, DArgento F, Khalek H, Ikka L . Flow-Diverter Stents for the Treatment of Saccular Middle Cerebral Artery Bifurcation Aneurysms. AJNR Am J Neuroradiol. 2015; 37(2):279-84. PMC: 7959957. DOI: 10.3174/ajnr.A4540. View

OKelly C, Krings T, Fiorella D, Marotta T . A novel grading scale for the angiographic assessment of intracranial aneurysms treated using flow diverting stents. Interv Neuroradiol. 2010; 16(2):133-7. PMC: 3277972. DOI: 10.1177/159101991001600204. View

Wagner K, Srinivasan V, Srivatsan A, Z Ghali M, Thomas A, Enriquez-Marulanda A . Outcomes after coverage of lenticulostriate vessels by flow diverters: a multicenter experience. J Neurosurg. 2019; 132(2):473-480. DOI: 10.3171/2018.8.JNS18755. View

Rankin J . Cerebral vascular accidents in patients over the age of 60. III. Diagnosis and treatment. Scott Med J. 1957; 2(6):254-68. View

Rangel-Castilla L, Munich S, Jaleel N, Cress M, Krishna C, Sonig A . Patency of anterior circulation branch vessels after Pipeline embolization: longer-term results from 82 aneurysm cases. J Neurosurg. 2016; 126(4):1064-1069. DOI: 10.3171/2016.4.JNS16147. View

Hanel R, Kallmes D, Lopes D, Nelson P, Siddiqui A, Jabbour P . Prospective study on embolization of intracranial aneurysms with the pipeline device: the PREMIER study 1 year results. J Neurointerv Surg. 2019; 12(1):62-66. PMC: 6996098. DOI: 10.1136/neurintsurg-2019-015091. View

Bhogal P, Martinez R, Gansladt O, Bazner H, Henkes H, Aguilar M . Management of Unruptured Saccular Aneurysms of the M1 Segment with Flow Diversion : A Single Centre Experience. Clin Neuroradiol. 2016; 28(2):209-216. DOI: 10.1007/s00062-016-0553-9. View

Briganti F, Delehaye L, Leone G, Sicignano C, Buono G, Marseglia M . Flow diverter device for the treatment of small middle cerebral artery aneurysms. J Neurointerv Surg. 2015; 8(3):287-94. DOI: 10.1136/neurintsurg-2014-011460. View

10.

Michelozzi C, Darcourt J, Guenego A, Januel A, Tall P, Gawlitza M . Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: complications, aneurysm sac occlusion, reabsorption, recurrence, and jailed branch modification at follow-up. J Neurosurg. 2018; 131(6):1751-1762. DOI: 10.3171/2018.7.JNS18654. View

11.

Sambu N, Curzen N . Monitoring the effectiveness of antiplatelet therapy: opportunities and limitations. Br J Clin Pharmacol. 2011; 72(4):683-96. PMC: 3195743. DOI: 10.1111/j.1365-2125.2011.03955.x. View

12.

Lu P, Zhang Y, Niu H, Wang Y . Comparison of endovascular treatment for middle cerebral artery aneurysm with a low-profile visualized intraluminal support stent or pipeline embolization device. Exp Ther Med. 2019; 18(3):2072-2078. PMC: 6676140. DOI: 10.3892/etm.2019.7775. View

13.

Chiu A, Cheung A, Wenderoth J, De Villiers L, Rice H, Phatouros C . Long-Term Follow-Up Results following Elective Treatment of Unruptured Intracranial Aneurysms with the Pipeline Embolization Device. AJNR Am J Neuroradiol. 2015; 36(9):1728-34. PMC: 7968755. DOI: 10.3174/ajnr.A4329. View

14.

Ravindran K, Enriquez-Marulanda A, Kan P, Renieri L, Limbucci N, Mangiafico S . Use of Flow Diversion for the Treatment of Distal Circulation Aneurysms: A Multicohort Study. World Neurosurg. 2018; 118:e825-e833. DOI: 10.1016/j.wneu.2018.07.062. View

15.

van Rooij W, Sluzewski M . Perforator infarction after placement of a pipeline flow-diverting stent for an unruptured A1 aneurysm. AJNR Am J Neuroradiol. 2010; 31(4):E43-4. PMC: 7964216. DOI: 10.3174/ajnr.A2034. View

16.

Pritz M, Chandler W . The transsylvian approach to middle cerebral artery bifurcation/trifurcation aneurysms. Surg Neurol. 1994; 41(3):217-9; discussion 219-20. DOI: 10.1016/0090-3019(94)90124-4. View

17.

Toccaceli G, Diana F, Cagnazzo F, Cannizzaro D, Lanzino G, Barbagallo G . Microsurgical Clipping Compared with New and Most Advanced Endovascular Techniques in the Treatment of Unruptured Middle Cerebral Artery Aneurysms: A Meta-Analysis in the Modern Era. World Neurosurg. 2020; 137:451-464.e1. DOI: 10.1016/j.wneu.2019.12.118. View

18.

Iosif C, Camilleri Y, Saleme S, Caire F, Yardin C, Ponomarjova S . Diffusion-weighted imaging-detected ischemic lesions associated with flow-diverting stents in intracranial aneurysms: safety, potential mechanisms, clinical outcome, and concerns. J Neurosurg. 2015; 122(3):627-36. DOI: 10.3171/2014.10.JNS132566. View

19.

Griessenauer C, Ogilvy C, Adeeb N, Dmytriw A, Foreman P, Shallwani H . Pipeline embolization of posterior circulation aneurysms: a multicenter study of 131 aneurysms. J Neurosurg. 2018; 130(3):923-935. DOI: 10.3171/2017.9.JNS171376. View

20.

Dabus G, Grossberg J, Cawley C, Dion J, Puri A, Wakhloo A . Treatment of complex anterior cerebral artery aneurysms with Pipeline flow diversion: mid-term results. J Neurointerv Surg. 2016; 9(2):147-151. DOI: 10.1136/neurintsurg-2016-012519. View