Preliminary experience of treating complex middle cerebral artery aneurysms with Pipeline embolization device / 中国脑血管病杂志

ABSTRACT

Objective To investigate the safety and efficacy of Pipeline embolization device (PED) for the treatment of complex middle cerebral artery aneurysms. Methods From December 2015 to June 2018, 7 patients with complex middle cerebral artery unruptured aneurysms and treated with PED at the Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University were recruited. The clinical and follow-up data were analyzed. The Kamran classification was used to evaluate the immediate effect of aneurysm embolization and the changes of parent artery. At 6 months after operation, the effect of embolization was evaluated by Raymond grading; the modified Rankin scale (mRS) was used to evaluate prognosis 0 -2 for good prognosis, 3 -6 for poor prognosis, and 6 for death. Results The 7 patients with complex middle cerebral artery aneurysms were successfully treated with one PED, including 2 patients with single PED and 5 combined with coiling. Digital subtraction angiography (DSA) were performed immediately after PED implantation. All had Kamran classification 2a at immediate angiography after embolization. The postoperative mRS score was 0 in 6 patients and 1 in 1 patient. One patient with M1 aneurysm had acute in-stent thrombosis and another one with M1 aneurysm had mini-focal occipital lobe cerebral infarction. All 7 patients were Raymond classification I during postoperative follow-up from 6 to 12 months. Among them, 6 patients had aneurysms total occlusion with patent parent artery. For the remaining one patient, the aneurysm was found slightly residual at the middle cerebral artery bifurcation but was totally occluded with parental artery patent at 12 months. There were no aneurysmal rupture, cerebral parenchymal hemorrhage, and neurological defects in the 7 patients during intraoperative and postoperative follow-up periods (6 to 18 months). Conclusions Embolization of complex cerebral artery aneurysms with PED is effective and safe, but its long-term effect still needs to be validated by longer follow-up results and large sample-sized trials.