Pipeline Embolization Device for the Treatment of Intracranial Pseudoaneurysms.

BACKGROUND: Intracranial pseudoaneurysms (PSA) are associated with high rupture and mortality rates and have traditionally been treated by parent vessel sacrifice. There has been recent interest in utilizing flow-diverting devices for treatment of these complex lesions while preserving flow through the parent artery.

OBJECTIVE: Examine the safety and efficacy of these devices in the treatment of intracranial PSA.

METHODS: We performed a multi-institutional retrospective study of intracranial PSA treated with the Pipeline Embolization device (PED, Medtronic) between 2014 and 2017 at 7 institutions. Complications, and clinical and radiographic outcomes were reviewed.

RESULTS: A total of 19 patients underwent PED placement for intracranial PSA. Iatrogenic injury and trauma comprised the majority of etiologies in our series. The mean pseudoaneurysm diameter 8.8 mm and 18/19 (95%) PSA involved the internal carotid artery (ICA). Multiple PED were deployed in a telescoping fashion in 7 patients (37%). Of the 18 patients with follow up imaging, 14 (78%) achieved complete pseudoaneurysm obliteration and two achieved near complete obliteration (11%). Two (11%) patients were found to have significant pseudoaneurysm progression on short-term follow-up and required ICA sacrifice. No patients experienced new neurologic deficits or deterioration secondary to PED placement. No patients experienced bleeding or rebleeding from PSA.

CONCLUSION: In well-selected patients, the use of flow-diverting stents may be a feasible alternative to parent vessel sacrifice. Given the high morbidity and mortality associated with PSA, we recommend short and long-term radiographic follow up for patients treated with flow-diverting stents.