Flow diversion treatment of anterior communicating artery region aneurysms - 12/11/20

Doi : 10.1016/j.neurad.2019.06.002

Krishna Amuluru ^a,^b,⁎ , Fawaz Al-Mufti ^c, Charles Edward Romero ^a
^a Goodman Campbell Brain and Spine, Ascension St. Vincent Medical Center, Division of Interventional Neuroradiology, Indianapolis IN, United States
^b Department of Interventional Neuroradiology, University of Pittsburgh Medical Center–Hamot, 300 State St, Suite 4100 Erie, 16550 PA, United States
^c Westchester Medical Center, Department of Endovascular Neurosurgery and Neurocritical Care, Valhalla, NY, United States

^⁎Corresponding author.

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Graphical abstract

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Highlights

•	Off-label uses of flow diversion include ruptured and distal circulation aneurysms.
•	Reports on flow diversion for anterior communicating artery aneurysms are limited.
•	Flow diversion for these aneurysms may be feasible and result in occlusion.

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Abstract

Background and purpose

Reports on flow diversion treatment of aneurysms beyond the Circle of Willis are limited, with few series dedicated to anterior communicating artery region aneurysms. The purpose of this study is to evaluate the safety and effectiveness of the pipeline embolization device in the treatment of anterior communicating artery region aneurysms.

Materials and methods

The neuro-interventional database of a single institution was retrospectively reviewed for anterior communicating artery aneurysms treated with the pipeline embolization device between November 2016 and December 2018. Data on clinical presentation, aneurysm location, type, vessel size, procedural complications, clinical and imaging follow-up were analyzed.

Results

Ten patients with 11 anterior communicating artery aneurysms were included. Procedural success was achieved in 9/10 patients (90%). Flow diversion with the pipeline embolization device yielded occlusion in 100% of patients at 6.5 months. Symptomatic ischemic complications occurred in 2/10 patients (20%); only one of who had permanent symptoms. Hemorrhagic groin complications were encountered in 2/10 patients (20%). There were no deaths and no cerebral hemorrhagic complications.

Conclusions

Flow diversion therapy may provide a feasible solution for anterior communicating artery region aneurysms that are not amenable to traditional surgical or endovascular modalities.

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Keywords : Anterior communicating artery, Embolization, Cerebral Aneurysm, Endovascular, Flow diversion, Pipeline Embolization Device

Abbreviations : ACA, ACoA, DSA, FD, ICA, IV, MCA, PED, SAH, TICI