Predictors of treatment outcome in pipeline stenting of anterior circulation cerebral saccular aneurysms

Abstract

AIM OF THE STUDY: This is a single centre retrospective study on the use of pipeline stenting in anterior circulation cerebral saccular aneurysms. METHODS: Pipeline stenting performed from 24/9/08 to 30/12/11 were retrospectively reviewed. There were 29 patients with 29 saccular, anterior circulation aneurysms with a mean imaging follow-up of 9.2 months. Characteristics including location, size, aspect ratio, neck width, prior treatment and the requirement for additional coiling were correlated with the success of aneurysm obliteration on follow-up angiograms (CTA / MRA / DSA). RESULTS: The 29 saccular aneurysms had a mean size of 6.99mm (SD = 4.42mm). The overall obliteration rate was 23 out of 29 (79.3%). All four posterior communicating artery aneurysms had incomplete obliteration. Three of these were wide-necked lesions. There were trends of lower obliteration rates with wide-necked (8 out of 13) when compared with narrow-necked aneurysms (1 out of 15), and with aneurysms that had prior treatments (2 out of 4 versus 21 out of 25) although the differences did not reach statistical significance. Size and aspect ratio were not correlated with treatment success. CONCLUSIONS: Wide-necked saccular aneurysms of the posterior communicating artery appeared to be more prone to incomplete obliteration. We also observed a trend of lower obliteration rate in aneurysms with prior treatment. Further large scale studies and computational models on fluid dynamics will help in identifying risk factors for incomplete obliteration.