Pipeline Embolization Device for the Treatment of Intra- and Extracranial Fusiform and Dissecting Aneurysms: Initial Experience and Long-term Follow-up

BACKGROUND: Flow-diverting stents offer a promising treatment option for complex aneurysms. OBJECTIVE: To evaluate the safety and efficacy of the Pipeline embolization device (PED) in the treatment of fusiform and dissecting aneurysms. METHODS: Sixty-five consecutive patients with 69 fusiform and dissecting aneurysms underwent endovascular treatment with the use of the PED. Target vessels included the internal carotid artery (n = 28), middle cerebral artery (n = 2), anterior cerebral artery (n = 1), vertebral artery (n = 20), basilar artery (n = 17), and posterior cerebral artery (n = 1). An average of 3.0 PEDs per target vessel were deployed. RESULTS: Exclusion of the aneurysm(s) immediately after PED deployment was not observed. Angiographic follow-up examinations were performed in 63/65 patients (67/69 lesions). They showed complete cure of the target lesion in the first follow-up angiography (3.4 months mean interval) in 24 (36%) cases, partial elimination in 30 (45%), and no improvement in 13 (19%). After the latest follow-up (>1 digital subtraction angiography, n = 49, 27.4 months mean interval) complete cure of the target lesion was observed in 33 (67%), partial elimination in 14 (29%), and no change in 2 (4%). Taking all follow-up examinations together, 39/67 (58%) aneurysms were cured. The morbidity and mortality in the entire series were 5% and 8%, respectively. CONCLUSION: Flow diverters offer a promising treatment option in fusiform and dissecting aneurysms. The introduction of flow diverters with different densities might help to identify the optimal amount of coverage needed given different anatomic presentations of fusiform and dissecting aneurysms.