Literature Review

Treatment of complex anterior cerebral artery aneurysms with Pipeline flow diversion: mid-term results

Selected in the Journal of NeuroInterventional Surgery by FERRAZ Fausto

Authors: Dabus G, Grossberg JA, Cawley CM, Dion JE, Puri AS, Wakhloo AK, Gonsales D, Aguilar-Salinas P, Sauvageau E, Linfante I, Hanel RA

Reference: J Neurointerv Surg. 2017 Feb;9(2):147-151

Published: February 2017

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Monday 06 March 2017

The off-label use of flow diverter stents (FD) has been increasing over time, and some complex or recanalized aneurysms are being treated with this technic nowadays.

This multicenter series reports their experience with the Pipeline device for 20 aneurysms of the Acom complex and beyond, including fusiform, saccular and recanalized lesions, none of them judged to be feasibly treated by conventional techniques.
The morphology of the aneurysms and the hemodynamic features of the Acom region were considered to be implicated in the formation, rupture and recanalization of the lesions.

Two events happened within 48 hour post-procedure. One minor (caudate infarct with no consequence) due to compression of the stent cells in the origin of the artery of Heubner and consequent occlusion, and one major (distal intraparenchymal hemorrhage) leading to death.
No patient presented clinical worsening, except that hemorrhage that yielded a mRs of 6.

During a mean 10 month angiographic follow-up of 16 aneurysms they found a near occlusion and occlusion rate of 75% and 4 lesions with residual filling. One patient showed 50% in-stent stenosis.

Besides the small sample size and relative short-term angiographic follow-up for some lesions, clinical and angiographic data are in accordance with other reports and supports the use of FD in the Acom complex, considering that this region can be challenging for treatment and may have worse evolution with conventional techniques.

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