• Ning Lin, Giuseppe Lanzino, Demetrius K Lopes, Adam S Arthur, Christopher S Ogilvy, Robert D Ecker, Travis M Dumont, Raymond D Turner, M Reid Gooch, Alan S Boulos, Peter Kan, Kenneth V Snyder, Elad I Levy, and Adnan H Siddiqui.
• *Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ‡Current affiliation: Department of Neurosurgery, Weill Cornell Medical College, New York City, New York; §Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; ¶Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois; ‖Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee; #Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; **Neuroscience Institute, Maine Medical Center, Portland, Maine; ‡‡Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona; §§Division of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina; ¶¶Department of Neurosurgery, Albany Medical Center, Albany, New York; ‖‖Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; ##Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ***Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ‡‡‡Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; §§§Jacobs Institute, Buffalo, New York.
• Neurosurgery. 2016 Jul 1; 79 (1): 14-22.

BackgroundUtilization of the Pipeline embolization device (PED) to treat distal carotid circulation aneurysms has not been well studied.ObjectiveTo report the collective experience of using PED to treat distal anterior circulation aneurysms.MethodsWe retrospectively reviewed clinical and radiographic records of all patients who underwent Pipeline embolization of distal anterior circulation aneurysms at 10 US neurosurgical centers between 2011 and 2013.ResultsTwenty-eight patients (mean age 51.7 years; 18 women) with 28 aneurysms were included in the analyses. Fifteen aneurysms were fusiform, 5 dissecting, and 8 saccular. Average aneurysm size was 12.3 mm; 7 were giant. Twenty aneurysms were located along the middle cerebral artery, 6 along the anterior cerebral artery, and 2 along the anterior communicating artery. PED deployment was successful in 27 patients, with coils utilized in 6 cases. Clinical follow-up was available for an average of 10.7 months (range 3-26). Twenty-seven patients had follow-up neurovascular imaging: 21 aneurysms had complete occlusion, 4 had residual neck filling, and 2 had residual dome filling. Periprocedural complications (<30 days) occurred in 3 patients (10.7%), including 1 case of device failure resulting in stroke. Outcomes were good (modified Rankin Scale score 0 to 2) in 27 patients (96.4%) and fair (modified Rankin Scale 3) in 1.ConclusionPED can be utilized in the treatment of distal anterior circulation aneurysms with difficult anatomy for conventional surgical or endovascular techniques. Larger-scale studies with long-term follow-up are needed to further elucidate the durability of PED treatment and its effect on perforator-rich vascular segments.AbbreviationsACA, anterior cerebral arteryAcomA, anterior communicating arteryDSA, digital subtraction angiographyMCA, middle cerebral arterymRS, modified Rankin scalePED, Pipeline embolization device.

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