Embolization device placement safe, effective for treating aneurysms

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PED treatment for aneurysm - 513.45 Kb
Angiogram of fusiform aneurysm of M1 segment of right middle cerebral artery after placement of two PEDs. Source: Radiology (doi: 10.1148/radiol.12120422)

Pipeline embolization device (PED) placement has been shown to be a reasonably safe and effective treatment for intracranial aneurysms, according to a study published online Sept. 20 in Radiology.

“The treatment is promising for aneurysms of unfavorable morphologic features, such as wide neck, large size, fusiform morphology, incorporation of side branches, and posttreatment recanalization, and should be considered a first choice for treating unruptured aneurysms and recurrent aneurysms after previous treatments,” wrote study authors Simon Chun-Ho Yu, MD, of Prince of Wales Hospital, Chinese University of Hong Kong, and colleagues.

Endovascular placement of flow diversion devices such as PEDs is gaining acceptance for treatment of intracranial aneurysms, explained the authors, and they devised a prospective nonrandomized multicenter study to evaluate midterm clinical and angiographic outcomes after PED placement.

Included in the study were 143 patients with 178 aneurysms who had unruptured saccular, fusiform aneurysms or recurrent aneurysms after a previous treatment. Patients were observed angiographically for up to 18 months and clinically for up to three years.

The authors reported an 84 percent complete aneurysm occlusion rate at 18 months, while instances of parent artery stenosis were extremely rare. Follow-up showed approximately three-quarters of patients with cranial nerve palsy became asymptomatic after PED treatment.

There were five cases of periprocedural death or major stroke, and another five patients had minor neurologic complications within 30 days, according to the authors. Complications were rare beyond 30 days and did not occur after the first year.

“A major concern with flow diverters is their inability to immediately occlude the aneurysm with the risk of aneurysm rupture during the ‘latency’ period,” wrote the authors, adding that the current study was no different in that occlusion occurred at a slow pace. Delayed rupture after PED treatment did not occur in aneurysms smaller than 20 mm in size.

For aneurysms larger than 20 mm, Yu and colleagues found that “the use of concomitant endosaccular coil placement at the time of flow diverter placement to build up a stable organized thrombus involving fibrin formation may be a reasonable treatment strategy to prevent post-treatment rupture. Adoption of such preventive measures in the current study had resulted in no further incidence of aneurysm rupture; further observation in a larger study is warranted to verify such a proposal.”