title: Treatment of distal anterior cerebral artery aneurysms with the Pipeline Embolization Device.
abstract: Aneurysms of the anterior cerebral artery (ACA) located distal to the anterior communicating artery complex (ACOM) remain challenging to treat with surgical clip reconstruction as well as with endovascular coil-embolization strategies. We have treated five complex geometry distal ACA aneurysms with endoluminal reconstruction using the Pipeline Embolization Device (PED). Two aneurysms were of the dysplastic fusiform type. Three aneurysms were of complex saccular configuration. Three aneurysms were treated electively at the outset with PED. One patient had previously undergone aborted clip reconstruction, and one was treated for recurrent aneurysm growth after coil embolization. The mean diameter of the ACA in this cohort was 1.96mm proximal to the aneurysm and 1.79mm distal to the aneurysmal segment. A single PED of 2.5mm inner diameter was the sole treatment in four cases. Two PEDs, telescopically overlapped across the aneurysm, were used in the remaining case. All devices were deployed successfully. No parent artery occlusion or stenosis was observed. In all cases an associated branch vessel arising from the vicinity of the aneurysm or incorporated into its neck was covered by the endoluminal construct. At follow-up angiography, robust antegrade flow was maintained in the jailed branch. One patient experienced asymptomatic, delayed occlusion of the jailed branch. Complete aneurysm occlusion was seen in all patients. We confirm that PED can be deployed in parent vessels smaller than 2mm diameter, and that endoluminal reconstruction with the PED may be a safe and effective treatment alternative for selected distal ACA aneurysms.
authors.affiliation: Division of Neurosurgery, Maimonides Medical Center, Brooklyn, NY, USA. Electronic address: ENossek@maimonidesmed.org.
authors.forename: Erez
authors.initials: E
authors.lastname: Nossek
authors.affiliation: Neurointerventional Section, Department of Radiology, Basel University Hospital, Basel, Switzerland.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Zumofen
authors.affiliation: Department of Neurosurgery, Hofstra School of Medicine, North Shore-Long Island Jewish Health System, Manhasset, New York, NY, USA; Department of Radiology, Hofstra School of Medicine, North Shore-Long Island Jewish Health System, Manhasset, New York, NY, USA.
authors.forename: Avi
authors.initials: A
authors.lastname: Setton
authors.affiliation: Departments of Neurological Surgery and Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Potts
authors.affiliation: Neurointerventional Section, Departments of Radiology and Neurological Surgery, New York University School of Medicine, New York, NY, USA.
authors.forename: Eytan
authors.initials: E
authors.lastname: Raz
authors.affiliation: Neurointerventional Section, Departments of Radiology and Neurological Surgery, New York University School of Medicine, New York, NY, USA.
authors.forename: Maksim
authors.initials: M
authors.lastname: Shapiro
authors.affiliation: Neurointerventional Section, Departments of Radiology and Neurological Surgery, New York University School of Medicine, New York, NY, USA.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Riina
authors.affiliation: Department of Radiology, Hospital Bellvitge, Barcelona, Spain.
authors.forename: Maria Angeles
authors.initials: MA
authors.lastname: De Miquel
authors.affiliation: Department of Neurosurgery, Hofstra School of Medicine, North Shore-Long Island Jewish Health System, Manhasset, New York, NY, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Chalif
authors.affiliation: Neurointerventional Section, Departments of Radiology and Neurological Surgery, New York University School of Medicine, New York, NY, USA.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Nelson
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Aneurysm; Anterior cerebral artery; Flow diverter; Pericallosal; Pipeline