title: Learning from failure: persistence of aneurysms following pipeline embolization.
abstract: OBJECTIVE A detailed analysis was performed of anterior circulation aneurysms treated with a Pipeline Embolization Device (PED) that did not progress to complete occlusion by 1-year follow-up. Angiography was performed with the purpose of identifying specific factors potentially responsible for these failed outcomes. METHODS From among the first 100 patients with anterior circulation aneurysms, 92 underwent 1-year follow-up angiography and were individually studied through review of their pre- and postembolization studies. RESULTS Nineteen aneurysms (21%) remained unoccluded at 12 months. Independent predictors of treatment failure, identified by logistic regression analysis, were found to be fusiform aneurysm morphology, decreasing dome-to-neck ratio, and the presence of a preexisting laser-cut stent. Further examination of individual cases identified several common mechanisms-device malapposition, inadequate coverage of the aneurysm neck with persistent exchange across the device, and the incorporation of a branch vessel into the aneurysm fundus-potentially contributing to failed treatment in these settings. CONCLUSIONS Attention to specific features of the aneurysm and device construct can frequently identify cases predisposed to treatment failure and suggest strategies to maximize favorable outcomes.
authors.affiliation: Departments of 1 Radiology, Bernard and Irene Schwartz Neurointerventional Radiology Section.|Neurology, and.
authors.forename: Maksim
authors.initials: M
authors.lastname: Shapiro
authors.affiliation: Department of Neurology, Rochester General Hospital, Rochester Regional Health System, Rochester, New York.
authors.forename: Tibor
authors.initials: T
authors.lastname: Becske
authors.affiliation: Departments of 1 Radiology, Bernard and Irene Schwartz Neurointerventional Radiology Section.|Neurosurgery, NYU School of Medicine, New York; and.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
keywords: ICA = internal carotid artery; MPED = minimally porous endoluminal device; PCoA = posterior communicating artery; PED = Pipeline Embolization Device; PRU = platelet reactivity unit; PUFS = Pipeline for Uncoilable or Failed Aneurysms; Pipeline Embolization Device; ROC = receiver operating characteristic; aneurysm; brain; vascular disorders