Abstract WMP29: Single-Center Experience with The Pipeline Embolization Device: The Treatment of Smaller Secondary Aneurysms

The Pipeline embolization device is a flow diverting stent that is now available as an FDA approved treatment for giant wide-neck cavernous and supraclinoid aneurysms. This revolutionary device has made it possible to safely treat large wide necked aneurysms with excellent results. There is limited information on the impact of Pipeline on smaller secondary aneurysms. We present single center data regarding Pipeline’s efficacy in the treatment of these aneurysms. Methods: Since August 2012, 24 patients have been electively treated utilizing the Pipeline Embolization Device (PED) (Covidien, Mansfield, MA) at Hartford Hospital. Of these patients, 17 patients have had follow up angiograms and 9 (52%) had smaller secondary aneurysms that was covered by the Pipeline stent. For each patient where angiographic follow-up was available, the degree of secondary aneurysm occlusion was assessed utilizing the Raymond criteria. Results: All procedures were successfully completed and a total of 41 PEDS were implanted. No intraprocedural complications were present. During the clinical follow-up period, no major complications resulted. One patient developed a partial CN III and IV neuropathy secondary to thrombosis of a large cavernous aneurysm 4 days following treatment. The results of 6 month follow-up angiography demonstrated that out of a total of 9 cases, 8 cases (89%) with smaller secondary aneurysms resolved and 1 case (11%) improved significantly. In all cases where the smaller secondary aneurysm was occluded, the larger primary aneurysm was also occluded. The single case of significant improvement demonstrated that the primary aneurysm had also significantly decreased in size. Conclusion: Smaller secondary aneurysms are adequately treated by Pipeline stenting. In all cases, the primary aneurysm either improved significantly or totally occluded along with the secondary aneurysms. This suggests that the Pipeline device, in addition to treating large wide-necked aneurysms, can effectively treat smaller associated aneurysms without the need for additional endovascular coiling. Key Words: Pipeline embolization device, giant wide-neck cavernous and supraclinoid aneurysm, secondary aneurysms