title: Anterior choroidal artery patency and clinical follow-up after coverage with the pipeline embolization device.
abstract: OBJECTIVE
  Endoluminal reconstruction with the Pipeline Embolization Device is an effective treatment option for select intracranial aneurysms. However, concerns for the patency of eloquent branch arteries covered by the Pipeline Embolization Device have been raised. We aimed to examine the patency of the anterior choroidal artery and clinical sequelae after ICA aneurysm treatment.
  
  
  METHODS
  We prospectively analyzed all patients among our first 157 patients with ICA aneurysms treated by the Pipeline Embolization Device who required placement of at least 1 device across the ostium of the anterior choroidal artery. The primary outcome measure was angiographic patency of the anterior choroidal artery at last follow-up. Age, sex, type of aneurysm, neurologic examination data, number of Pipeline Embolization Devices used, relationship of the anterior choroidal artery to the aneurysm, and completeness of aneurysm occlusion on follow-up angiograms were also analyzed.
  
  
  RESULTS
  Twenty-nine aneurysms requiring placement of at least 1 Pipeline Embolization Device (median = 1, range = 1-3) across the anterior choroidal artery ostium were identified. At angiographic follow-up (mean = 15.1 months; range = 12-39 months), the anterior choroidal artery remained patent, with antegrade flow in 28/29 aneurysms (96.5%), while 24/29 (82.7%) of the target aneurysms were angiographically occluded by 1-year follow-up angiography. Anterior choroidal artery occlusion, with retrograde reconstitution of the vessel, was noted in a single case. A significant correlation between the origin of the anterior choroidal artery from the aneurysm dome and failure of the aneurysms to occlude following treatment was found.
  
  
  CONCLUSIONS
  After placement of 36 Pipeline Embolization Devices across 29 anterior choroidal arteries (median = 1 device, range = 1-3 devices), 1 of 29 anterior choroidal arteries was found occluded on angiographic follow-up. The vessel occlusion did not result in persistent clinical sequelae. Coverage of the anterior choroidal artery origin with the Pipeline Embolization Device, hence, may be considered reasonably safe when deemed necessary for aneurysm treatment.
authors.affiliation: From the Bernard and Irene Schwartz Interventional Neuroradiology Section (E.R., M.S., T.B., D.W.Z., M.P.B., H.A.R., P.K.N.), Department of Radiology.
authors.forename: E
authors.initials: E
authors.lastname: Raz
authors.affiliation: From the Bernard and Irene Schwartz Interventional Neuroradiology Section (E.R., M.S., T.B., D.W.Z., M.P.B., H.A.R., P.K.N.), Department of Radiology Departments of Neurology (M.S., T.B.).
authors.forename: M
authors.initials: M
authors.lastname: Shapiro
authors.affiliation: From the Bernard and Irene Schwartz Interventional Neuroradiology Section (E.R., M.S., T.B., D.W.Z., M.P.B., H.A.R., P.K.N.), Department of Radiology Departments of Neurology (M.S., T.B.).
authors.forename: T
authors.initials: T
authors.lastname: Becske
authors.affiliation: From the Bernard and Irene Schwartz Interventional Neuroradiology Section (E.R., M.S., T.B., D.W.Z., M.P.B., H.A.R., P.K.N.), Department of Radiology Neurosurgery (D.W.Z., O.T., M.B.P., H.A.R., P.K.N.), New York University School of Medicine, New York, New York.
authors.forename: D W
authors.initials: DW
authors.lastname: Zumofen
authors.affiliation: Neurosurgery (D.W.Z., O.T., M.B.P., H.A.R., P.K.N.), New York University School of Medicine, New York, New York.
authors.forename: O
authors.initials: O
authors.lastname: Tanweer
authors.affiliation: Neurosurgery (D.W.Z., O.T., M.B.P., H.A.R., P.K.N.), New York University School of Medicine, New York, New York.
authors.forename: M B
authors.initials: MB
authors.lastname: Potts
authors.affiliation: From the Bernard and Irene Schwartz Interventional Neuroradiology Section (E.R., M.S., T.B., D.W.Z., M.P.B., H.A.R., P.K.N.), Department of Radiology Neurosurgery (D.W.Z., O.T., M.B.P., H.A.R., P.K.N.), New York University School of Medicine, New York, New York.
authors.forename: H A
authors.initials: HA
authors.lastname: Riina
authors.affiliation: From the Bernard and Irene Schwartz Interventional Neuroradiology Section (E.R., M.S., T.B., D.W.Z., M.P.B., H.A.R., P.K.N.), Department of Radiology Neurosurgery (D.W.Z., O.T., M.B.P., H.A.R., P.K.N.), New York University School of Medicine, New York, New York. peter.nelson@nyumc.org.
authors.forename: P K
authors.initials: PK
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014654:Vascular Patency