PT  - JOURNAL ARTICLE
AU  - N. Adeeb
AU  - C.J. Griessenauer
AU  - A.A. Dmytriw
AU  - H. Shallwani
AU  - R. Gupta
AU  - P.M. Foreman
AU  - H. Shakir
AU  - J. Moore
AU  - N. Limbucci
AU  - S. Mangiafico
AU  - A. Kumar
AU  - C. Michelozzi
AU  - Y. Zhang
AU  - V.M. Pereira
AU  - C.C. Matouk
AU  - M.R. Harrigan
AU  - A.H. Siddiqui
AU  - E.I. Levy
AU  - L. Renieri
AU  - T.R. Marotta
AU  - C. Cognard
AU  - C.S. Ogilvy
AU  - A.J. Thomas
TI  - Risk of Branch Occlusion and Ischemic Complications with the Pipeline Embolization Device in the Treatment of Posterior Circulation Aneurysms
AID  - 10.3174/ajnr.A5696
DP  - 2018 Jul 01
TA  - American Journal of Neuroradiology
PG  - 1303--1309
VI  - 39
IP  - 7
4099  - http://www.ajnr.org/content/39/7/1303.short
4100  - http://www.ajnr.org/content/39/7/1303.full
SO  - Am. J. Neuroradiol.2018 Jul 01; 39
AB  - BACKGROUND AND PURPOSE: Flow diversion with the Pipeline Embolization Device is increasingly used for endovascular treatment of intracranial aneurysms due to high reported obliteration rates and low associated morbidity. While obliteration of covered branches in the anterior circulation is generally asymptomatic, this has not been studied within the posterior circulation. The aim of this study was to evaluate the association between branch coverage and occlusion, as well as associated ischemic events in a cohort of patients with posterior circulation aneurysms treated with the Pipeline Embolization Device.MATERIALS AND METHODS: A retrospective review of prospectively maintained databases at 8 academic institutions from 2009 to 2016 was performed to identify patients with posterior circulation aneurysms treated with the Pipeline Embolization Device. Branch coverage following placement was evaluated, including the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and posterior cerebral artery. If the Pipeline Embolization Device crossed the ostia of the contralateral vertebral artery, its long-term patency was assessed as well.RESULTS: A cohort of 129 consecutive patients underwent treatment of 131 posterior circulation aneurysms with the Pipeline Embolization Device. Adjunctive coiling was used in 40 (31.0%) procedures. One or more branches were covered in 103 (79.8%) procedures. At a median follow-up of 11 months, 11% were occluded, most frequently the vertebral artery (34.8%). Branch obliteration was most common among asymptomatic aneurysms (P < .001). Ischemic complications occurred in 29 (22.5%) procedures. On multivariable analysis, there was no significant difference in ischemic complications in cases in which a branch was covered (P = .24) or occluded (P = .16).CONCLUSIONS: There was a low occlusion incidence in end arteries following branch coverage at last follow-up. The incidence was higher in the posterior cerebral artery and vertebral artery where collateral supply is high. Branch occlusion was not associated with a significant increase in ischemic complications.PCAposterior cerebral arteryPEDPipeline Embolization DeviceVAvertebral artery