title: Safety, efficacy, and short-term follow-up of the use of Pipeline Embolization Device in small (<2.5 mm) cerebral vessels for aneurysm treatment: single institution experience.
abstract: BACKGROUND
  Flow diversion is being increasingly used to treat cerebral aneurysms. We present our experience using these stents to treat aneurysms distal to the circle of Willis with parent arteries smaller than 2.5 mm.
  
  
  METHODS
  Aneurysms treated with a Pipeline Embolization Device in vessels less than 2.5 mm between June 2012 and August 2014 were included. We evaluated risk factors, family history of aneurysms, aneurysm characteristics, National Institute of Health Stroke Scale (NIHSS), and modified Rankin scale (mRS) on admission and angiography and clinical outcome at discharge, 6 months, and 1 year.
  
  
  RESULTS
  We included seven patients with a mean age of 65 years. The parent vessel size ranged from 1.5 to 2.3 mm; mean 1.9 mm. Location of the aneurysms was as follows: two aneurysms centered along the pericallosal artery (one left, one right), one on the right angular artery, one aneurysm at the anterior communicating artery (ACom), one at the ACom-right A2 anterior cerebral artery (ACA), one at the lenticulostriate artery, and one at the A1-A2 ACA artery. Aneurysms ranged from 1 to 12 mm in diameter. All aneurysms were treated with a single Pipeline Embolization Device (PED). No peri- or post-procedural complications or mortality occurred. The patients were discharged with no change in NIHSS or mRS score. Angiographic follow-up was available in six patients. Angiography showed complete aneurysm occlusion in all. NIHSS and mRS remained unchanged at follow-up.
  
  
  CONCLUSIONS
  Our preliminary results show that flow diversion technology is an effective and safe therapy for aneurysms located on small cerebral arteries. Larger studies with long-term follow-up are needed to validate our promising results.
authors.affiliation: Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA. ajit.puri@umassmemorial.org.
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Puri
authors.affiliation: Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.affiliation: Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Asai
authors.affiliation: Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Miklos
authors.initials: M
authors.lastname: Marosfoi
authors.affiliation: Department of Neurosurgery, University of South Florida College of Medicine, Tampa, FL, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kan
authors.affiliation: Stroke and Neurovascular Center of Central California, Santa Barbara, CA, USA.
authors.forename: Samuel Y
authors.initials: SY
authors.lastname: Hou
authors.affiliation: Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Howk
authors.affiliation: Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Perras
authors.affiliation: Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Brooks
authors.affiliation: Department of Interventional Neuroradiology, Pitie-Salpetriere Hospital, Paris, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Clarencon
authors.affiliation: Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gounis
authors.affiliation: Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Wakhloo
mesh_terms: D000368:Aged; D001807:Blood Vessel Prosthesis; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome
keywords: Flow diversion; Flow diverter stents; Intracranial aneurysm; Pipeline™ Embolization Device; Small arteries