Effect of structural remodeling (retraction and recoil) of the pipeline embolization device on aneurysm occlusion rate.
OBJECTIVE
During endovascular treatment of unruptured aneurysms with the Pipeline Embolization Device, an oversized device is often selected to achieve better wall apposition; however, this device oversizing could be related to overelongation and possible delayed enlargement of the stented region. The purpose of this study is to investigate the relationship between oversize and treatment outcome.


METHODS
The DynaCT images of 14 aneurysms treated by a single Pipeline Embolization Device were retrospectively analyzed. 3D images of the deployed device were compared with those acquired at the 6-month follow-up for qualitative and quantitative evaluation. The diameter and length of the Pipeline Embolization Device were measured at both time points and compared for determination of the device changes.


RESULTS
Structural changes of the device have been observed, and it was found that the Pipeline Embolization Device influences the vessel curvature in some cases. On average, it increases its diameter by 0.23 mm and decreases its length by 2.88 mm within 6 months of initial deployment. Excessive elongation beyond its nominal length is correlated with a lower aneurysm occlusion rate at the 6-month follow-up.


CONCLUSIONS
Not only does a Pipeline Embolization Device reconstruct the aneurysm and parent artery, but its entire structure goes through a gradual remodeling process. The relative deformation between the device and the artery indicates suboptimal wall apposition. Device oversizing does not have a direct effect on shortening or recoil. The aneurysm occlusion rate, however, is lowered by overelongation of the Pipeline Embolization Device.
From the Departments of Radiology (L.-D.J., H.M.S., M.E.M.) jou@bcm.tmc.edu.
L-D
LD
Jou
Neurosurgery (B.D.M.), Baylor College of Medicine, Houston, Texas.
B D
BD
Mitchell
From the Departments of Radiology (L.-D.J., H.M.S., M.E.M.).
H M
HM
Shaltoni
From the Departments of Radiology (L.-D.J., H.M.S., M.E.M.).
M E
ME
Mawad
D001158:Arteries / Q000601:surgery; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome