Change in the angle of the anterior genu is associated with occlusion rate after Pipeline flow diversion

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OBJECTIVE

The Pipeline embolization device (PED) is a self-expanding mesh stent that diverts blood flow away from an aneurysm; it has been successfully used to treat aneurysms of the proximal internal carotid artery (ICA). PEDs have a remarkable ability to alter regional blood flow along the tortuous segments of the ICA and were incidentally found to alter the angle of the anterior genu after treatment. The authors quantified these changes and explored their implications as they relate to treatment effect.

METHODS

The authors retrospectively reviewed cases of aneurysms treated with a PED between the ophthalmic and posterior communicating arteries from 2012 through 2015. The angles of the anterior genu were measured on the lateral projections of cerebral angiograms obtained before and after treatment with a PED. The angles of the anterior genu of patients without aneurysms were used as normal controls.

RESULTS

Thirty-eight patients were identified who had been treated with a PED; 34 (89.5%) had complete obliteration and 4 (10.5%) had persistence of their aneurysm at last follow-up (mean 11.3 months). After treatment, 32 patients had an increase, 3 had a decrease, and 3 had no change in the angle of the anterior genu. The average measured angle of the anterior genu was 36.7° before treatment and 44.3° after treatment (p < 0.0001). The average angle of the anterior genu of control patients was 43.32° (vs 36.7° for the preoperative angle in the patients with aneurysms, p < 0.057). The average change in the angle of patients with postoperative Raymond scores of 1 was 9.10°, as compared with 1.25° in patients with postoperative Raymond scores > 1 (p < 0.001).

CONCLUSIONS

Treatment with a PED significantly changes the angle of the anterior genu. An average change of 9.1° was associated with complete obliteration of treated aneurysms. These findings have important implications for the treatment and management of cerebral aneurysm.

ABBREVIATIONS ICA = internal carotid artery; PED = Pipeline embolization device.

Article Information

Correspondence Philipp Taussky: Clinical Neurosciences Center, University of Utah, Salt Lake City, UT. neuropub@hsc.utah.edu.

INCLUDE WHEN CITING Published online January 18, 2019; DOI: 10.3171/2018.9.JNS18726.

Disclosures Dr. Taussky reports a consultant relationship with Medtronic.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Schematic of the effect of the Pipeline flow diverter on the angle of the anterior genu. A: Preoperative. B: Postoperative. Figure is available in color online only.

  • View in gallery

    Cerebral angiogram obtained in a 78-year-old woman with a cavernous ICA aneurysm. A: The angle of the genu before PED treatment was 22°. B: The angle 1 year after PED treatment was 42°.

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