title: Treatment of vertebrobasilar fusiform aneurysms with Pipeline embolization device.
abstract: OBJECTIVE
  Treatment of complex intracranial aneurysms with Pipeline embolization device (PED) (ev3/Covidien Vascular Therapies) has gained recent popularity. One application of PEDs that is not well described in the literature is the utility and long-term safety in treatment of vertebrobasilar fusiform (VBF) aneurysms. Despite the advancements in endovascular therapy, VBF aneurysms continue to challenging pathology. The authors provide long-term follow-up of VBF aneurysms treated with PEDs.
  
  
  METHODS
  We retrospectively reviewed four patients that were treated at Louisiana State University Health Sciences Center in Shreveport with PEDs for VBFs from 2012 to 2014. Each patient was discussed in a multidisciplinary setting between neurosurgeons and neurointerventionalists. Each patient underwent platelet function tests to ensure responsiveness to anti-platelet agents and was treated by one neurointerventionalist (HC). All patients were placed on aspirin and Plavix and were confirmed for therapeutic response prior to discharge.
  
  
  RESULTS
  Follow-up ranged from 12 to 25 months, with a mean of 14.25 months. Two cases presented with a recurrence after the initial treatment, both of which required subsequent treatment. Of the four patients treated, one patient developed hemiparesis and three died.
  
  
  CONCLUSIONS
  Despite reports describing successful treatment of VBF aneurysms with PEDs, delayed complications after obliteration and remodeling can occur. We describe our institutional experience of VBFs treated with PEDs. Treatment of holobasilar fusiform aneurysms may carry a worse prognosis after treatment. Further long-term follow-up will provide a better understanding of this pathology.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Osama
authors.initials: O
authors.lastname: Ahmed
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Storey
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Piyush
authors.initials: P
authors.lastname: Kalakoti
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Jai
authors.initials: J
authors.lastname: Deep Thakur
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Shihao
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Bharat
authors.initials: B
authors.lastname: Guthikonda
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA hcuell@lsuhsc.edu.
authors.forename: Hugo
authors.initials: H
authors.lastname: Cuellar
mesh_terms: D000328:Adult; D000368:Aged; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D061214:Patient Safety; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010979:Platelet Function Tests; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Fusiform aneurysm; endovascular treatment; flow diverting stent; vertebrobasilar aneurysm