title: Treatment of complex anterior cerebral artery aneurysms with Pipeline flow diversion: mid-term results.
abstract: BACKGROUND
  The off-label use of flow diverters in the treatment of distal aneurysms continues to be debated.
  
  
  OBJECTIVE
  To report our multicenter experience in the treatment of complex anterior cerebral artery aneurysms with the Pipeline embolization device (PED).
  
  
  METHODS
  The neurointerventional databases of the four participating institutions were retrospectively reviewed for aneurysms treated with PED between October 2011 and January of 2016. All patients treated for anterior cerebral artery aneurysms were included in the analysis. Clinical presentation, location, type, vessel size, procedural complications, clinical and imaging follow-up were included in the analysis.
  
  
  RESULTS
  Twenty patients (13 female) with 20 aneurysms met the inclusion criteria in our study. Fifteen aneurysms were classified as saccular and five as fusiform (mean size 7.3 mm). Thirteen aneurysms were located in the anterior communicating region (ACOM or A1/2 junction), six were A2-pericallosal, and one was located in the A1 segment. Six patients had presented previously with subarachnoid hemorrhage and had their aneurysms initially clipped or coiled. There was one minor event (a small caudate infarct) and one major event (intraparenchymal hemorrhage). Sixteen of the 20 patients had angiographic follow-up (mean 10 months). Eleven aneurysms were completely occluded, one had residual neck, and four had residual aneurysm filling.
  
  
  CONCLUSIONS
  The treatment of complex anterior cerebral artery aneurysms with the PED as an alternative for patients who are not good candidates for conventional methods is technically feasible and safe. Mid-term results are promising but larger series with long-term follow-up are required to assess its effectiveness.
authors.affiliation: Miami Cardiac & Vascular Institute, Florida International University, Miami, Florida, USA.|Baptist Neuroscience Center, Florida International University, Miami, Florida, USA.|Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Dabus
authors.affiliation: Departments of Radiology and Neurosurgery, Emory University, Atlanta, Georgia, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Grossberg
authors.affiliation: Departments of Radiology and Neurosurgery, Emory University, Atlanta, Georgia, USA.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cawley
authors.affiliation: Departments of Radiology and Neurosurgery, Emory University, Atlanta, Georgia, USA.
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Dion
authors.affiliation: Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA.
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Puri
authors.affiliation: Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Wakhloo
authors.affiliation: Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Gonsales
authors.affiliation: Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida, USA.
authors.forename: Pedro
authors.identifier: http://orcid.org/0000-0002-5268-6548
authors.initials: P
authors.lastname: Aguilar-Salinas
authors.affiliation: Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Sauvageau
authors.affiliation: Miami Cardiac & Vascular Institute, Florida International University, Miami, Florida, USA.|Baptist Neuroscience Center, Florida International University, Miami, Florida, USA.|Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
authors.forename: Italo
authors.initials: I
authors.lastname: Linfante
authors.affiliation: Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida, USA.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Hanel
mesh_terms: D000328:Adult; D000368:Aged; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*; D002544:Cerebral Infarction / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies
keywords: Aneurysm; Angiography; Flow Diverter; Intervention