1177. Pipeline Embolization Device as a Primary Treatment Modality for Iatrogenic Vessel Wall Injury

Authors: Monica C. Mureb; Pankaj Sharma, MD; Omar Tanweer, MD; Jan-Karl Burkhardt, MD; Eytan Raz, MD; Maksim Shapiro, MD; Howard Riina, MD; Peter Nelson, MD (New York, NY)

Introduction: Iatrogenic injuries to intracranial vasculature are a known and potentially dire surgical complication. The incidence of internal carotid artery (ICA) injuries during endoscopic sinus surgeries ranges from 0.2-1%. Postoperative complications include pseudoaneurysms, carotid cavernous fistula, and stroke. Management includes vessel sacrifice, suture repair, muscle graft and aneurysm clipping. In this paper, we present our experience with Pipeline Embolization Device (PED) in the treatment of iatrogenic injuries to intracranial vasculature. Methods: This is a retrospective study of cases from 2009 to 2017 at tertiary care centers. PED was used for treatment in 5 patients. We reviewed angiography images, procedure notes, 6-month follow-ups, and complication rates. Results: All patients were females with mean age of 48.4 years. 3 had injury to paraophthalmic, paraclinoid and cavernous segment of ICA. One patient had injury to P1. All had a pseudoaneurysm at the site of injury. 4 patients underwent embolization within a week of iatrogenic injury (mean = 5 d) One embolization was performed after 56 days. 4 patients with 6-month cerebral angiograms had no residual pseudoaneurysm and demonstrated excellent vessel remodeling and healing. One patient reported cranial neuropathy involving CN III and V. No patients had a stroke. We averaged 1.8 PED per case. Conclusion: Early identification and control of arterial injury is critical. We report our experience of 5 patients with iatrogenic vessel wall injury managed with endoluminal reconstruction using PED. Other reports used 1 PED/case with a 50% failure to occlude the pseudoaneurysm. We owe our success of vessel repair to the use of multiple PEDs, which mimics the use of a covered stent but with the ease of using catheters and stents designed for cerebral vessels.