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Research ArticleInterventional
Open Access

Treatment of Intracranial Aneurysms by Functional Reconstruction of the Parent Artery: The Budapest Experience with the Pipeline Embolization Device

I. Szikora, Z. Berentei, Z. Kulcsar, M. Marosfoi, Z.S. Vajda, W. Lee, A. Berez and P.K. Nelson
American Journal of Neuroradiology June 2010, 31 (6) 1139-1147; DOI: https://doi.org/10.3174/ajnr.A2023
I. Szikora
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Z. Berentei
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Z. Kulcsar
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M. Marosfoi
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Z.S. Vajda
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W. Lee
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A. Berez
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P.K. Nelson
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  • Fig 1.
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    Fig 1.

    Giant cavernous carotid aneurysm, with the patient presenting with third and sixth nerve palsy due to mass effect (patient 16, On-line Table and Tables 1 and 2), treated with flow modification. A, DSA, right ICA injection, oblique posteroanterior view before treatment demonstrates a giant partially thrombosed aneurysm (arrow). B, DSA, right ICA injection, oblique posteroanterior view, immediately following implantation of 3 coaxial PEDs across the neck of the aneurysm, demonstrates significantly reduced flow (arrow). C, Fluoroscopic image demonstrates the implanted PEDs (arrow) and delayed contrast stasis (broken arrow) within the aneurysm. D, Six-month follow-up angiogram demonstrates complete occlusion of the aneurysm and reconstruction of the parent artery. E, T2-weighted axial MR image of the same patient before treatment demonstrates the giant ICA aneurysm (arrow) with associated significant mass effect. F, Follow-up MR image at 12 months demonstrates collapse of the aneurysm and resolution of the mass effect.

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    Fig 2.

    Giant infrasupraclinoid aneurysm of the right ICA. The patient presented with loss of vision due to mass effect (patient 13, On-line Table and Tables 1 and 2) and was treated with flow modification with transient thrombosis of the parent artery. A, DSA, right ICA injection, demonstrates bilobulated giant aneurysm (arrows). B, DSA, same view, following implantation of 2 coaxial PEDs, demonstrates partial in-stent thrombosis (arrow). C, DSA, same view, following tirofiban thrombolysis, demonstrates recanalization of the ICA (arrow) and significantly reduced flow within the aneurysm (broken arrow). D, Complete thrombosis of the ICA 2 days later. E, DSA, right vertebral artery injection, demonstrates good collateral circulation toward the right carotid system. No further action was taken at this time. F, Six-month follow-up angiogram demonstrates residual filling of the inferior portion of the aneurysm only (arrow).

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    Fig 3.

    Giant dissecting aneurysm of the basilar trunk in a 16-year-old boy presenting with mass effect and sudden onset of hemiparesis (On-line Table and Tables 1 and 2, patient 18.). A, T1-weighted sagittal MR image demonstrates a basilar trunk aneurysm with mass effect (arrow). B, DSA, left vertebral artery injection, posteroanterior view, demonstrates the aneurysm (arrow). Small arrows demonstrate the origin of both duplicated SCAs; broken arrow demonstrates the origin of the left AICA. C, Fluoroscopic image following the procedure. Large arrows demonstrate the distal (white) and proximal (black) edges of the 5 coaxial PEDs that were used to reconstruct the lumen of the BA. Small arrows demonstrate the SCAs, and the broken arrow demonstrates the AICA, which are both covered by the flow-modifying devices. D, Six-month follow-up angiogram demonstrates complete occlusion of the aneurysm and reconstruction of the BA. Small arrows represent the duplicated SCAs, and the broken arrow demonstrates the left AICA. All of them are patent. E, T1-weighted MR image 7 months after treatment demonstrates collapse of the aneurysm and resolution of the mass effect. Signal intensity void due to metal artifacts is seen in the treated section of the BA.

  • Fig 4.
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    Fig 4.

    Results of aneurysm treatment by a combination of flow modification and additional coil packing. A and B, Nine-millimeter-diameter paraophthalmic aneurysm (arrow, B) treated with flow modification and coil packing (patient 3, On-line Table and Tables 1 and 2). C, Six-month follow-up angiogram demonstrates complete occlusion of the aneurysm with reconstruction of the parent artery. Arrows demonstrate subtraction artifacts and nonsubtracted view of the coil mass (23.3% volumetric packing attenuation); broken arrow demonstrates a single PED within the ICA.

  • Fig 5.
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    Fig 5.

    Results of aneurysm treatment with flow modification only. A and B, Aneurysm with size and location similar to the one on Fig 4 (10-mm diameter paraophthalmic ICA aneurysm; arrow, B) treated with flow modification only (patient 11, On-line Table and Tables 1 and 2). C, Six-month follow-up angiogram demonstrates complete occlusion of the aneurysm and reconstruction of the parent artery (arrow). D, Arrow represents 3 coaxial PEDs implanted for parent artery reconstruction. No coils were used.

Tables

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    Table 1:

    Immediate and 6 months angiographic results of 19 aneurysms treated with PED

    Patient IDSide Branch OcclusionImmed Angiographic Occlusion6-Month Angiographic Occlusion
    ImmediateFollow-UpCompleteIncompleteComplete OcclusionNear-Complete Occlusion
    111
    111
    2111
    311
    411
    511
    611
    7111
    811
    91N/AN/A
    10111
    1111
    1211
    1311
    1411
    1511
    1611
    1711
    1811
    Total12415171
    • View popup
    Table 2:

    Complications and clinical outcome of 19 aneurysms treated in 18 patients with PED

    Patient IDComplicationsClinical Outcome
    In-Stent ThrombosisSide Branch EmbolizationDistal ThromboembolicHemorrhagicOtherUnchangedImprovedWorsened
    11
    11
    21
    31
    411
    51
    61
    711
    81
    91
    1011
    111
    121
    1311
    141
    151
    161
    171
    181
    Total110117111
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American Journal of Neuroradiology: 31 (6)
American Journal of Neuroradiology
Vol. 31, Issue 6
1 Jun 2010
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Treatment of Intracranial Aneurysms by Functional Reconstruction of the Parent Artery: The Budapest Experience with the Pipeline Embolization Device
I. Szikora, Z. Berentei, Z. Kulcsar, M. Marosfoi, Z.S. Vajda, W. Lee, A. Berez, P.K. Nelson
American Journal of Neuroradiology Jun 2010, 31 (6) 1139-1147; DOI: 10.3174/ajnr.A2023

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Treatment of Intracranial Aneurysms by Functional Reconstruction of the Parent Artery: The Budapest Experience with the Pipeline Embolization Device
I. Szikora, Z. Berentei, Z. Kulcsar, M. Marosfoi, Z.S. Vajda, W. Lee, A. Berez, P.K. Nelson
American Journal of Neuroradiology Jun 2010, 31 (6) 1139-1147; DOI: 10.3174/ajnr.A2023
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