• Christoph J Griessenauer, Alejandro Enriquez-Marulanda, Philipp Taussky, Arundhati Biswas, Ramesh Grandhi, Sissi Xiang, Tao Hong, Lorenzo Rinaldo, Giuseppe Lanzino, Waleed Brinjikji, Jan-Karl Burkhardt, Peter Kan, Mandeep Ghuman, YangVictor X DVXDDepartments of Medical Imaging & Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada., Karen Chen, Mohammad A Aziz-Sultan, Mohammad Ghorbani, Clemens M Schirmer, Oded Goren, Shamsher S Dalal, Monika Killer-Oberpfalzer, Erasmia Müller-Thies-Broussalis, Matthew J Koch, Christopher J Stapleton, Aman B Patel, Paul M Foreman, Marshall C Cress, Robert A Hirschl, Timo Krings, Hongqi Zhang, and Adam A Dmytriw.
• Department of Neurosurgery, Geisinger, Danville, Pennsylvania.
• Neurosurgery. 2020 Nov 16; 87 (6): 1252-1261.

BackgroundThe Pipeline Embolization Device (PED; Medtronic) has been used off-label for the treatment of challenging posterior circulation aneurysms. Data on this modality are primarily limited to small retrospective single-center series.ObjectiveTo assess safety and efficacy of this treatment by establishing an international, multicenter collaboration.MethodsConsecutive posterior circulation aneurysms treated with the PED from 2012 to 2019 across 11 neurovascular centers were retrospectively reviewed. Baseline demographics, aneurysm and treatment characteristics, complications, occlusion status, and functional outcome were assessed.ResultsThere were 149 posterior circulation aneurysms treated with PED in 146 patients. A total of 24 (16.4%) patients presented with subarachnoid hemorrhage. Most aneurysms were dissecting/blister (36.2%) in morphology, followed by saccular (35.6%) and fusiform (28.2%). The most common locations were the vertebral (51.7%) and basilar arteries (22.8%). Complete or near-complete occlusion (>90%) was achieved in 90.9% of aneurysms at a median follow-up of 12 mo. Dissecting/blister aneurysms were most likely to occlude (P = .06). Symptomatic neurologic complications occurred in 9.4% of aneurysms, associated with larger size, ruptured presentation, presentations with brain stem compression, cranial nerve palsy, or stroke. Favorable functional outcome (modified Rankin Score 0-2) was achieved in 86.2% of patients. There were 6 fatalities of which 4 occurred in aneurysmal subarachnoid hemorrhage patients.ConclusionThis multicenter study shows that PED for the treatment of posterior circulation is preferentially used for the treatment of fusiform and dissecting/blister aneurysm morphologies. Despite the challenges presented by these less-common morphologies, flow diversion may be performed with a neurologic complication rate of about 10% and favorable long-term aneurysm occlusion rates.Copyright © 2020 by the Congress of Neurological Surgeons.

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