Flow diverter for endovascular treatment of intracranial mirror segment internal carotid artery aneurysms

Anna Luisa Kühn, Peter Kan, Visish Srinivasan, David E. Rex, Katyucia de Macedo Rodrigues, Mary C. Howk, Ajay K. Wakhloo, Ajit S. Puri

Research output: Contribution to journalArticle

Abstract

Background: To evaluate the feasibility and efficacy of the pipeline embolization device in the treatment of unruptured intracranial mirror segment aneurysms. Methods: Out of a total of 338 subjects, 14 were identified harboring a total of 32 internal carotid artery mirror segment aneurysms that were treated with the pipeline embolization device and were consecutively enrolled into our study. We collected data on patient demographics, modified Rankin scale (mRS) at admission, aneurysm characteristics, clinical outcome at discharge, 3–9 and at 12–18 months as well as angiography results at follow-up. Results: Patients’ mean age was 52.9 years; baseline mRS was 0 in all subjects. Pipeline embolization device placement was successful in all cases. Post-treatment mRS remained 0 in 13/14 patients. One patient experienced a small intraparenchymal hemorrhage and subarachnoid hemorrhage, associated with a frontoparietal infarction resulting in right upper extremity weakness and aphasia (post-treatment mRS 3). His mRS evaluation remained stable at the 3–9-month follow-up. Three to 9-month follow-up angiography (13/14 subjects) showed complete aneurysm occlusion in 24/30 aneurysms (80%), near complete and partial occlusion in three of 30 (10%) aneurysms each. At the 9-month follow-up, one patient experienced a complete occlusion of the anterior temporal artery branch but did not present with any clinical deficits. No mRS changes were encountered over a median 6-month follow-up period. Mid-term follow-up angiography (12–18 months) available in eight of 14 subjects showed complete aneurysm occlusion in all patients. Mild intimal hyperplasia was observed in one patient. Conclusions: Flow diversion technology can be used for the treatment of unruptured mirror segment aneurysms in selected patients.

Original languageEnglish (US)
Pages (from-to)4-11
Number of pages8
JournalInterventional Neuroradiology
Volume25
Issue number1
DOIs
StatePublished - Feb 1 2019

Keywords

  • Endovascular treatment
  • flow diverter
  • mirror segment aneurysms
  • pipeline embolization device

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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    Kühn, A. L., Kan, P., Srinivasan, V., Rex, D. E., de Macedo Rodrigues, K., Howk, M. C., Wakhloo, A. K., & Puri, A. S. (2019). Flow diverter for endovascular treatment of intracranial mirror segment internal carotid artery aneurysms. Interventional Neuroradiology, 25(1), 4-11. https://doi.org/10.1177/1591019918792536