1179. Pipeline embolization device for the treatment of partially thrombosed intracranial aneurysms

Authors: Paul Foreman, MD; Christoph Griessenauer; Anna Kuhn; Mohamed Salem; Alejandro Bugarini; Luis Ascanio; Santiago Gomez; Kimberly Kicielinski; Christopher Ogilvy; Ajith Thomas (Birmingham, AL)

Introduction

The Pipeline Embolization Device (PED) is a flow diverting stent that has demonstrated safety and efficacy for the treatment of intracranial aneurysms. Efficacy of the device is dependent on the ability of the parent artery to remodel allowing for aneurysm thrombosis and occlusion. We hypothesize that the occlusion rates for partially thrombosed aneurysms will be reduced, potentially as a result of the chemical milieu of the thrombus.

Methods

We performed a multicenter retrospective cohort study of partially thrombosed intracranial aneurysms that were treated with the PED between 2014-2017. Descriptive statistics were performed to evaluate aneurysm occlusion rates and complication rates.

Results

Fourteen patients with 15 partially thrombosed aneurysms were included with a mean age of 67.1 years (range 46-81). Three patients presented with subarachnoid hemorrhage from the index aneurysm and 4 patients with cranial nerve dysfunction. Twelve (80%) aneurysms were in the anterior circulation. Three aneurysms were dolichoectatic or fusiform in morphology with the remaining 12 saccular or multilobulated. Nine (64.3%) of the 14 aneurysms with imaging follow up were completely occluded with 4 (28.6%) incompletely occluded and 1 (7.1%) larger. No patient suffered a reduction in modified Rankin Scale and all patients were discharged to home.

Conclusion

The pipeline embolization device is safe for the treatment of partially thrombosed intracranial aneurysms. The occlusion rates of these aneurysms is lower than what is commonly reported in the literature.