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Treatment of Posterior Circulation Aneurysms With the Pipeline Embolization Device

Chalouhi, Nohra MD; Tjoumakaris, Stavropoula MD; Dumont, Aaron S. MD; Gonzalez, L. Fernando MD; Randazzo, Ciro MD; Starke, Robert M. MD; Rosenwasser, Robert H. MD; Jabbour, Pascal MD

doi: 10.1227/NEU.0b013e31828ba984
Research-Human-Clinical Studies

BACKGROUND: Treatment of complex intracranial aneurysms with the pipeline embolization device (PED) has become common practice in neurovascular centers. Very few studies have assessed the safety and efficacy of PED treatment for posterior circulation aneurysms.

OBJECTIVE: To retrospectively present our experience with use of the PED in the posterior circulation.

METHODS: A total of 7 patients harboring 7 posterior circulation aneurysms were treated with the PED at our institution between November 2011 and July 2012.

RESULTS: Aneurysm size was 14.1 mm on average. All patients had unruptured aneurysms. Three aneurysms arose from the vertebral artery, 2 from the basilar artery, and 2 from the vertebrobasilar junction. A single stent was used in 4 patients, 2 stents in 2 patients, and 3 stents in 1 patient. Treatment was successful in all 7 patients. No procedural complications or perforator infarcts were noted in the series. No patient experienced new neurological symptoms related to PED treatment during the follow-up period. Angiographic follow-up was available for 6 patients at a mean time point of 5.5 months. Follow-up angiography showed 100% aneurysm occlusion in 3 patients, marked decrease in aneurysm size in 2 patients, and no change in 1 patient.

CONCLUSION: In our initial experience, it appears that PED treatment in select patients with vertebrobasilar aneurysms may have a reasonable safety-efficacy profile. Larger studies are needed to confirm our findings.

ABBREVIATIONS: PED, pipeline embolization device

PICA, posterior inferior cerebellar artery

Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania

Correspondence: Pascal M. Jabbour, MD, Associate Professor, Department of Neurological Surgery, Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut St, 2nd Floor, Philadelphia PA 19107. E-mail: pascal.jabbour@jefferson.edu

Received October 23, 2012

Accepted January 22, 2013

Copyright © by the Congress of Neurological Surgeons