Proposal of a follow-up imaging strategy following Pipeline flow diversion treatment of intracranial aneurysms

Raghav Gupta; Christopher S Ogilvy; Justin M Moore; Christoph J Griessenauer; Alejandro Enriquez-Marulanda; Madeline Leadon; Nimer Adeeb; Luis Ascanio; Georgios A Maragkos; Abhi Jain; Philip G R Schmalz; Abdulrahman Y Alturki; Kimberly Kicielinski; Clemens M Schirmer; Ajith J Thomas

doi:10.3171/2018.2.JNS172673

Proposal of a follow-up imaging strategy following Pipeline flow diversion treatment of intracranial aneurysms

J Neurosurg. 2019 Jul 1;131(1):32-39. doi: 10.3171/2018.2.JNS172673. Epub 2018 Jul 13.

Authors

Raghav Gupta¹, Christopher S Ogilvy¹, Justin M Moore¹, Christoph J Griessenauer^{1

2}, Alejandro Enriquez-Marulanda¹, Madeline Leadon¹, Nimer Adeeb¹, Luis Ascanio¹, Georgios A Maragkos¹, Abhi Jain², Philip G R Schmalz¹, Abdulrahman Y Alturki¹, Kimberly Kicielinski¹, Clemens M Schirmer², Ajith J Thomas¹

Affiliations

¹ 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and.
² 2Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania.

PMID: 30004284
DOI: 10.3171/2018.2.JNS172673

Abstract

Objective: There is currently no standardized follow-up imaging strategy for intracranial aneurysms treated with the Pipeline embolization device (PED). Here, the authors use follow-up imaging data for aneurysms treated with the PED to propose a standardizable follow-up imaging strategy.

Methods: A retrospective review of all patients who underwent treatment for ruptured or unruptured intracranial aneurysms with the PED between March 2013 and March 2017 at 2 major academic institutions in the US was performed.

Results: A total of 218 patients underwent treatment for 259 aneurysms with the PED and had undergone at least 1 follow-up imaging session to assess aneurysm occlusion status. There were 235 (90.7%) anterior and 24 posterior (9.3%) circulation aneurysms. On Kaplan-Meier analysis, the cumulative incidences of aneurysm occlusion at 6, 12, 18, and 24 months were 38.2%, 77.8%, 84.2%, and 85.1%, respectively. No differences in the cumulative incidence of aneurysm occlusion according to aneurysm location (p = 0.39) or aneurysm size (p = 0.81) were observed. A trend toward a decreased cumulative incidence of aneurysm occlusion in patients 70 years or older was observed (p = 0.088). No instances of aneurysm rupture after PED treatment or aneurysm recurrence after occlusion were noted. Sixteen (6.2%) aneurysms were re-treated with the PED; 11 of these had imaging follow-up data available, demonstrating occlusion in 3 (27.3%).

Conclusions: The authors propose a follow-up imaging strategy that incorporates 12-month digital subtraction angiography and 24-month MRA for patients younger than 70 years and single-session digital subtraction angiography at 12 months in patients 70 years or older. For recurrent or persistent aneurysms, re-treatment with the PED or use of an alternative treatment modality may be considered.

Keywords: DSA = digital subtraction angiography; ICA = internal carotid artery; PED = Pipeline embolization device; cerebrovascular; flow diversion; follow-up imaging; intracranial aneurysm; mRS = modified Rankin Scale; occlusion rate; rupture; vascular disorders.