• Ahmad Sweid, Sage P Rahm, Somnath Das, Michael P Baldassari, Pascal Jabbour, Tyler D Alexander, Lohit Velagapudi, Nohra Chalouhi, Michael R Gooch, Nabeel Herial, Robert H Rosenwasser, and Stavropoula Tjoumakaris.
• Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
• World Neurosurg. 2019 Oct 1; 130: e1116-e1121.

BackgroundNearly 20% of individuals with an aneurysm will have multiple aneurysms-these individuals are at increased risk of subarachnoid hemorrhage. Treatment of bilateral aneurysms with flow diverters (FDs), or Pipeline embolization device, has not yet been established as an effective therapy. We evaluated the safety and efficacy of a 2-stage treatment of bilateral aneurysms with Pipeline embolization devices placed 6 months apart.MethodsWe performed a retrospective review to analyze the clinical and angiographic outcomes of 16 individuals with bilateral aneurysms treated with 2-stage flow diversion at a tertiary referral center from January 2010 to July 2018.ResultsOf the 16 patients with 33 aneurysms treated with bilateral flow diversion, 1 had 2 aneurysms treated with a single FD on the contralateral side. The aneurysms treated were ophthalmic, superior hypophyseal, posterior communicating, or cavernous segment aneurysms, with an average size of 6.5 mm. No major complications, such as in-stent stenosis, thromboembolic events, distal intraparenchymal hemorrhage, rerupture, stent migration, or neurological death, were recorded. All the patients had good functional outcomes. At the 24-month follow-up examination, 81% of aneurysms showed complete occlusion. No aneurysm required repeat treatment.ConclusionsThe results from the present study have demonstrated that 2-stage treatment of bilateral aneurysms with FDs is both safe and efficacious. The timing of contralateral FD stent placement is critical. We found that 6 months allows for adequate neurological recovery and stent endothelialization.Copyright © 2019 Elsevier Inc. All rights reserved.

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