AUTHOR=Chen Jigang , Tao Mushun , Han Jiangli , Feng Xin , Peng Fei , Tong Xin , Niu Hao , Ma Ning , Liu Aihua 

TITLE=Pipeline Embolization Device for the Treatment of Unruptured Intracranial Dissecting Aneurysms

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.691897

DOI=10.3389/fneur.2021.691897

ISSN=1664-2295

ABSTRACT=Abstract  
Background: Intracranial dissecting aneurysms (IDAs) are rare but pose significant challenges to the treatment. Pipeline Endovascular Device (PED) has demonstrated to be an effective treatment option with excellent outcomes. We report our experience with patients treated with PED for unruptured IDAs. 

Methods: We retrospectively reviewed our hospital database and identified patients who were treated with PEDs for unruptured IDAs between March 2016 and September 2020. Information was collected including demographics, clinical presentation, aneurysms characteristics, procedural details, intra- or peri-procedural complications, and follow-up.

Results: A total of 80 patients (61 men, 76.25%) were treated with PED for unruptured IDAs. The most common symptoms were headache (34, 42.5%), dizziness (29, 36.25%), and nausea or vomiting (15, 18.75%). Of these patients, 73 had 1aneurysm, and 7 harbored 2 aneurysms. All of them achieved a successful PED deployment. Six patients experienced intra- or peri-procedural complications including perforator artery occlusion, thromboembolic and hemorrhagic events, and falling of stent into the aneurysm sac. Follow-up with digital subtractive angiography was available for 29 patients with a median of 6 months and 28 (96.56%) patients had aneurysm occlusion. Late thrombosis occurred in 4 patients and 2 of them had unpleasant outcomes. Clinical follow-up showed that a favorable clinical outcome was achieved in 76 (95%) patients and the mortality rate was 3.75%.

Conclusion: Treating unruptured IDAs is safe and effective with long-term favorable clinical and angiographic outcomes. However, the complications of this treatment should be noted. Careful selection of appropriate patients and individualized antiplatelet therapy might be needed.