Long-Term Effect of Flow Diversion on Large and Giant Aneurysms: MRI-DSA Clinical Correlation Study.
BACKGROUND
The long-term effect of flow diversion (FD) on aneurysms has not been well studied.


OBJECTIVE
We aimed to assess the effect of the Pipeline embolization device (Covidien, Irvine, California, USA) on large and giant intracranial aneurysms with magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) and then correlate with clinical follow-up.


METHODS
We conducted a retrospective analysis of aneurysms treated solely with Pipeline without adjunctive therapy. The largest aneurysm diameters were compared with pretreatment and post treatment MRI and correlated with DSA and clinical symptoms.


RESULTS
Twelve patients harboring large and giant saccular unruptured aneurysms, treated with Pipeline, were included. Mean follow-up times were as follows: MRI 22.8 months (range 1-57), DSA 18.2 months (range 1-33), and clinical 29 months (range 1-48). Ten (83%) of 12 treated aneurysms decreased in size on MRI, which was first seen at an average of 17 months (range 4-57). In 70% of patients the change was noted on MRI ≤1 year after treatment, at an average of 9.1 months (range 4-12). MRI reduction was more likely in angiographically occluded aneurysms. Five aneurysms with complete occlusion on early angiogram showed size reduction on MRI only at ≥12 months. Mean aneurysm size reduction was 57% (range 19.6-94.2), which correlated well with improvement of cranial neuropathies in 75% and headaches in 100% of patients.


CONCLUSIONS
Most aneurysms treated with Pipeline decreased in size, correlating with clinical improvement. Some aneurysms remained unchanged on MRI until a later time point despite early DSA occlusion. It may be reasonable to eliminate early postprocedural imaging and start follow-up only as late as 1 year after FD treatment in clinically stable, asymptomatic patients.
Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
Seby
S
John
Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
Mark D
MD
Bain
Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
M Shazam
MS
Hussain
Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
Andrew M
AM
Bauer
Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: tothg@ccf.org.
Gabor
G
Toth
D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D008137:Longitudinal Studies; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D011474:Prosthesis Design; D020127:Recovery of Function; D015607:Stents; D016896:Treatment Outcome
Aneurysm; Digital subtraction angiography; Flow diversion; Giant; Magnetic resonance imaging; Pipeline