Carolina Parada MD, Presenter: Nothing to Disclose

Jorge Pablo Chudyk MD, Abstract Co-Author: Nothing to Disclose

Hector Eduardo Lambre MD, Abstract Co-Author: Nothing to Disclose

Pedro Lylyk MD, Abstract Co-Author: Consultant, Medtronic, Inc Consultant, Surpass Medical Ltd Consultant, Cardiatis SA

Data including long-term follow up imaging using MR-MRA in the evolution of large and giant intracranial aneurysms treated with PED is still missing. We report our experience in the review and analysis of the primary MR–MRA findings on the evolution of these challenging aneurysms after treatment.

From a total of 570 intracranial aneurysms treated with PED in a period between 2006 and 2013 a total of 92 were included with the following criteria: 1) large and giant intracranial aneurysms treated with PED and 2) MR–MRA follow up. All imaging studies were performed every 6 months the first year, and annually after that, with a 3T magnet (Philips Healthcare, Best, the Netherlands) and included FLAIR, T1, T2, MRA and postgadolinium T1.

76% aneurysms were located in the anterior circulation being 58% supraclinoid and the remaining 24% originated at the posterior circulation with 64% at the basilar trunk. The MRA showed complete occlusion in 66% with most of them occluded in a six month period after treatment, 79% of these from the anterior circulation and 21% from the posterior circulation. The postgadolinium T1 from the DSA confirmed occluded group showed enhancement of the sac in 31% in less than one year after treatment, finding that could be related to complete endothelialization. 34% aneurysms showed signs of residual neck or sac with a predominance of the C7 segment. The MRA also revealed shrinkage and total regression of the aneurysms in 60% with a dominance of the supraclinoid segment (40%) while 32% remain without changes in size and 8% showed an increase of size with predominance of the anterior circulation (80%). The aneurysms parenchymal environment was examined reporting 79% with no surroundings alterations and 21% with perilesional edema that showed resolution after treatment.

MRA absence of signal intensity of the occluded aneurysms after treatment that show postgadolinium T1 enhancement of the sac does not mean permeability of the lumen although could suggest complete endothelialization. The results also support the reliability of the use of PED in the treatment of this challenging aneurysms.

Our data provide good correlation to DSA follow up supporting MR-MRA as an effective non-invasive method which should be considered for initial follow up.

Parada, C, Chudyk, J, Lambre, H, Lylyk, P, Large and Giant Intracranial Aneurysms Treated with Pipeline Embolization Device — MR-MRA Imaging Primary Findings: A Single Center Experience.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14001128.html