Preliminary application of pipeline embolization device in the treatment of large or giant wide-necked aneurysms of the internal carotid artery

Abstract:

Objective：To preliminarily explore the clinical effect of pipeline embolization device in the treatment of large or giant wide-necked aneurysms of the internal carotid artery. Methods：A retrospective analysis was performed on the clinical data of 14 pa－tients with large or giant wide-necked aneurysms of the internal carotid artery who were treated with PED from April 2016 to April 2018 in the neurosurgery department of our hospital. And the clinical efficacy was evaluated by Kamran grading，modified Rankin Scale（mRS），and radiological examination. Results：There were 15 aneurysms in 14 patients，all of which were large or giant wide-necked unruptured aneurysms of the internal carotid artery，Two cases were implanted with PED alone，while in the other 12 cases PED was given concurrently with coil embolization. Among these cases，PED was successfully released in 13 cases but failed in 1 case whose PED herniated into the lumen of the aneurysm. Immediately after the successful placement of PED，the contrast agent showed obvious retention in the lumen of the aneurysm. Postoperative complications occurred in 2 cases（14%），cranial nerve palsy worsened in 1 case，and thrombotic events happened in 1 case. At discharge，mRS score was 0 in 12 cases and 1 in 2 cases. At 6 months after surgery，14 patients underwent digital subtraction angiography. Thirteen patients had complete or nearly complete occlusion of aneurysm，and one with PED hernia into the lumen of the aneurysm had occlusion of the artery with aneurysm，and only blepharoptosis was left in this patient. During follow-up at 6 to 21 months，no symptoms of neurological defects were found in the remaining 13 patients. Conclusion：PED in the treatment of large or giant wide-necked aneurysms of the internal carotid artery has good therapeutic efficacy and safety in short-term evaluation. PED combined with coil embolization can improve the occlusion rate and may reduce the risk of postoperative aneurysm rupture and bleeding，but its long-term efficacy still needs further evaluation.