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Treatment of Blister-Like Aneurysms With the Pipeline Embolization Device

Chalouhi, Nohra MD*; Zanaty, Mario MD*; Tjoumakaris, Stavropoula MD*; Gonzalez, L. Fernando MD*; Hasan, David MD; Kung, David MD*; Rosenwasser, Robert H. MD*; Jabbour, Pascal MD*

doi: 10.1227/NEU.0000000000000309
Research-Human-Clinical Studies

BACKGROUND: Endovascular vessel reconstruction with the pipeline embolization device (PED) has become common practice. Data on the safety and efficacy of the PED in blister-like aneurysms (BLAs) are limited.

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

METHODS: A total of 8 patients harboring 8 BLAs were treated with the PED at our institution between November 2011 and April 2013.

RESULTS: Aneurysm size was 2.5 mm on average. Five patients had sustained a subarachnoid hemorrhage (SAH), 1 patient presented with sentinel headaches, and in 2 patients the aneurysm was incidentally discovered. Seven aneurysms arose from the ICA and 1 from the basilar artery. Placement of the PED was successful in all 8 patients. There were no procedural or perioperative complications in any of the patients. At the latest follow-up, all 8 patients achieved a favorable outcome (mRS 0-2). Angiographic follow-up was available for 6 patients at a mean time point of 3.9 months. Follow-up angiography showed 100% aneurysm occlusion in 5 patients and marked decrease in aneurysm size in 1 patient.

CONCLUSION: The findings of this study suggest that the PED may be a safe and effective treatment for BLAs. Given the limitations of other treatment modalities and the challenging nature of BLAs, flow diversion may be a valuable option for these lesions.

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

Department of Neurosurgery, University of Iowa, Iowa City, Iowa

Correspondence: Pascal M. Jabbour, MD, Associate Professor and Director, Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut Street, 3rd Floor, Philadelphia, PA 19107. E-mail: pascal.jabbour@jefferson.edu

Received November 28, 2013

Accepted January 24, 2014

Copyright © by the Congress of Neurological Surgeons