title: Incidence and clinical implications of carotid branch occlusion following treatment of internal carotid artery aneurysms with the pipeline embolization device.
abstract: BACKGROUND
  The use of flow diverters such as the pipeline embolization device (PED) for treatment of intracranial aneurysms carries the risk of side branch occlusion.
  
  
  OBJECTIVE
  To determine the incidence and clinical outcomes associated with supraclinoid internal carotid artery (ICA) branch occlusion after deployment of PEDs for ICA aneurysms.
  
  
  METHODS
  We reviewed patients who underwent endovascular treatment with PEDs for ICA aneurysms between June 2011 and March 2013. Forty-nine patients (43 women, mean age 56.3±1.8 years, 68 aneurysms) in whom PEDs traversed the origin of supraclinoid ICA branches (ophthalmic [OA], posterior communicating [PcommA], and anterior choroidal artery [AChA]) were selected for this study. Follow-up angiograms (mean follow-up, 12.8±0.8 months) were studied to determine the location of PEDs and the patency of ICA branches.
  
  
  RESULTS
  PEDs were placed across the ostia of 49 OAs, 14 PcommAs, and 11 AChAs. Multiple PEDs were deployed in 16 patients. Rate of branch occlusion was 4% (2/49) for the OA, 7.1% (1/14) for the PcommA, and 0% for the AChA. Patients with branch occlusion did not endure new neurological deficits. ICA branch occlusion was not associated with the number of PEDs covering the ostia (P=.76) or the origin of ICA branches from the aneurysm (P=.24).
  
  
  CONCLUSIONS
  The incidence of major supraclinoid ICA branch occlusion after treatment with PEDs was low. These events were not associated with new neurological deficits nor were they related to the number of PEDs deployed or the origin of ICA branches from the aneurysm.
authors.affiliation: *Baylor St. Luke's Medical Center, Houston, Texas; ‡Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; §Department of Radiology, Baylor College of Medicine, Houston, Texas.
authors.forename: Aditya
authors.initials: A
authors.lastname: Vedantam
authors.forename: Vikas Y
authors.initials: VY
authors.lastname: Rao
authors.forename: Hashem M
authors.initials: HM
authors.lastname: Shaltoni
authors.forename: Michel E
authors.initials: ME
authors.lastname: Mawad
mesh_terms: D000328:Adult; D000368:Aged; D020215:Carotid Artery, Internal, Dissection / Q000601:surgery*; D016893:Carotid Stenosis / Q000453:epidemiology* / Q000209:etiology*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged