Large and giant aneurysms of the internal carotid artery (ICA) have a poor prognosis when left untreated.1,2 Parent artery occlusion and endosaccular coiling have been considered the standard treatment modalities for these lesions in the past. Parent artery occlusion with or without bypass3 has been shown to result in high long-term occlusion rates in the subset of ICA aneurysms proximal to the ophthalmic segment but is associated with moderately high complication rates.4 Conversely, endosaccular coiling of complex aneurysms, with or without stent assistance, is considered relatively safe but has been shown to result in high rates of aneurysm recanalization, often requiring retreatment.5–7 Endoluminal reconstruction with the Pipeline Embolization Device (PED) has emerged as a viable and often preferable alternative to traditional endosaccular coiling and parent artery occlusion techniques.8,9 By excluding the aneurysm from the parent artery, the PED promotes thrombosis of the aneurysm sac and neointimal overgrowth at the aneurysm neck, both of which serve to prevent aneurysm growth and rupture and ultimately lead to aneurysm occlusion.10
The Pipeline for Uncoilable or Failed Aneurysms (PUFS) study is a multicenter, prospective, single-arm interventional trial of PED for treatment of uncoilable or failed aneurysms of the ICA. We previously reported 180-d, 1-, and 3-yr angiographic and clinical outcomes, which demonstrated high angiographic success rates and low complication rates.8,11 Here, we report results from patients presenting for 5-yr clinical and angiographic follow-up as part of the PUFS trial.
From Long-Term Clinical and Angiographic Outcomes Following Pipeline Embolization Device Treatment of Complex Internal Carotid Artery Aneurysms: Five-Year Results of the Pipeline for Uncoilable or Failed Aneurysms Trial by Tibor Becske, MD; Waleed Brinjikji, MD; Matthew B. Potts, MD; David F. Kallmes, MD; Maksim Shapiro, MD; Christopher J. Moran, MD; Elad I. Levy, MD; Cameron G. McDougall, MD; István Szikora, MD PhD; Giuseppe Lanzino, MD; Henry H. Woo, MD; Demetrius K. Lopes, MD; Adnan H. Siddiqui, MD PhD; Felipe C. Albuquerque, MD; David J. Fiorella, MD PhD; Isil Saatci, MD; Saruhan H. Cekirge, MD; Aaron L. Berez, MD; Daniel J. Cher, MD; Zsolt Berentei, MD; Miklós Marosfői, MD; Peter K. Nelson, MD