Patency of anterior circulation branch vessels after Pipeline embolization: longer-term results from 82 aneurysm cases

J Neurosurg. 2017 Apr;126(4):1064-1069. doi: 10.3171/2016.4.JNS16147. Epub 2016 Jun 10.


OBJECTIVE The Pipeline Embolization Device (PED) has become increasingly used for the treatment of intracranial aneurysms. Given its high metal surface area coverage, there is concern for the patency of branch vessels that become covered by the device. Limited data exist regarding the patency of branch vessels adjacent to aneurysms that are covered by PEDs. The authors assessed the rate of intracranial internal carotid artery, anterior circulation branch vessel patency following PED placement at their institution. METHODS The authors retrospectively reviewed the records of 82 patients who underwent PED treatment between 2009 and 2014 and in whom the PED was identified to cover branch vessels. Patency of the anterior cerebral, posterior communicating, anterior choroidal, and ophthalmic arteries was evaluated using digital subtraction angiography preoperatively and postoperatively after PED deployment and at longer-term follow-up. RESULTS Of the 127 arterial branches covered by PEDs, there were no immediate postoperative occlusions. At angiographic follow-up (mean 10 months, range 3-34.7 months), arterial side branches were occluded in 13 (15.8%) of 82 aneurysm cases and included 2 anterior cerebral arteries, 8 ophthalmic arteries, and 3 posterior communicating arteries. No cases of anterior choroidal artery occlusion were observed. Patients with branch occlusion did not experience any neurological symptoms. CONCLUSIONS In this large series, the longer-term rate of radiographic side branch arterial occlusion after coverage by a flow diverter was 15.8%. Terminal branch vessels, such as the anterior choroidal artery, remained patent in this series. The authors' series suggests that branch vessel occlusions are clinically silent and should not deter aneurysm treatment with flow diversion.

Keywords: ACA = anterior cerebral artery; AChA = anterior choroidal artery; DSA = digital subtraction angiography; ICA = internal carotid artery; MRA = MR angiography; OphA = ophthalmic artery; PCoA = posterior communicating artery; PED = Pipeline Embolization Device; Pipeline device; artery branch; endovascular; flow diversion; intracranial aneurysm; patency; vascular disorders.

MeSH terms

  • Adult
  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / surgery
  • Angiography, Digital Subtraction
  • Carotid Artery, Internal / diagnostic imaging
  • Carotid Artery, Internal / surgery
  • Cerebral Angiography
  • Embolization, Therapeutic* / instrumentation
  • Embolization, Therapeutic* / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Ophthalmic Artery / diagnostic imaging
  • Ophthalmic Artery / surgery
  • Prospective Studies
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome