IntroductionLoeys-Dietz Syndrome (LDS) is a hereditary aortopathy characterized by arterial tortuosity and aneurysmal disease involving the proximal aorta, cerebral, iliac, and mesenteric vessels. ...Cervical vessel tortuosity (CVT) has previously been associated with more aggressive aortic disease in patients with connective tissue disorders, including LDS. However, the relationship between CVT and intracranial aneurysms has not been previously evaluated. In this study we aim to create a global scoring system for carotid CVT, and apply these metrics to determine whether carotid CVT could be a predictive marker for cervical dissection and intracranial aneurysm in LDS.Materials and MethodsExtracranial carotid arteries of 57 LDS patients and 50 age-matched controls were evaluated based on 6 measures of tortuosity (figure 1): peak curvature (κmax), number of curves, tortuosity index (TI), vessel length, total absolute curvature (TC), and average absolute curvature (AC). Vessel segmentation, generation of 3D surface models, and computation of centerlines were performed using the Vascular Modeling Toolkit library. Machine learning logistic regression algorithms were used to determine which metrics best predict outcomes of cervical vessel dissection and intracranial aneurysm. Statistical analyses used Mann-Whitney U tests for continuous and Monte Carlo simulation tests for categorical variables.ResultsLDS patients had higher tortuosity, number of curves, curvature indices, and vessel lengths compared with controls. 11 patients with LDS had a prior cervical vessel dissection (19.3%). Numbers of curves was an excellent predictor for cervical vessel dissection (AUC=0.096), with the number of cervical carotid curves >4 being an optimal marker for predicting dissection of a cervical vessel (specificity 75.0%, sensitivity 100%, and PPV 66.7%). Intracranial aneurysms were identified in 14 patients (22.8%). Peak curvature was a good predictor (AUC=0.889), with a peak curvature >0.485 being an optimal marker for presence of an intracranial aneurysm (specificity 88.9%, sensitivity 100%, and PPV 75.0%). There was no significant association between increased tortuosity index or total absolute curvature and presence of an intracranial aneurysm.ConclusionIn patients with LDS, the number of cervical vessel curves is a useful predictor for risk of cervical vessel dissection, while focal peak curvature is the best predictor for presence of an intracranial aneurysm. Both metrics are relatively accessible to clinicians without advanced vessel modeling, making them excellent candidates for a rapidly deployable screening tool. Importantly, while increased two- or three-dimensional metrics of tortuosity are predictors of aortic pathology, they are not associated with an increased risk for intracranial aneurysm.Abstract E-037 Figure 1Disclosures A. Huguenard: 4; C; Aurenar. V. Lee: None. R. Dacey: None. A. Braverman: None. J. Osbun: None.
IntroductionSeveral techniques of aspiration thrombectomy for acute ischemic stroke are commonly performed. With the availability of larger microwires with soft and torqueable distal ends that can be ...advanced intracranially, and the advent of aspiration catheters with softer distal ends, techniques to perform aspiration thrombectomy without the traditional triaxial system have been developed. In this study, we examined our experience with direct aspiration thrombectomy utilizing aspiration catheter and a large (0.024 in.) microwire.MethodsA retrospective analysis of prospectively collected database of consecutive patients who underwent mechanical thrombectomy at our center were analyzed. Patient demographics, stroke severity (on the NIH stroke scale), technical details and reperfusion outcomes (modified TICI score), complications were evaluated. All included patients included had ICA terminus, M1, proximal M2 occlusions or combinations thereof. All procedures were performed with a large microwire (Aristotle 0.024 in.) Aspiration catheters used were variable and selected by the treating surgeon. These included 6 Fr or 5 Fr Sofia, Red 72/68/62/43, 4 Max, 3Max, Zoom 71/55, and Apro 70.ResultsAmong 245 patients with large vessel occlusions, aspiration catheter over microwire was successfully utilized in 109 patients (44%) (Group 1), aspiration catheter over microwire-microcatheter assembly was required in 36 patients (15%) either as first line technique or after failed attempt over microwire without microcatheter (Group 2), ‘SNAKE’ technique was used in 18 patients (7%) (Group 3), and stent retriever after failed aspiration thrombectomy in 82 patients (33%) (Group 4). Mean number of passes was significantly higher in Group 4 (3.171±1.153) compared to Group 1 and Group 2, and lesser in Group 3 (1.167±0.384) versus Group 2.Reperfusion outcomes were also similar between the various groups- Group 1 (TICI 2C/3 = 88%, 2B=11%), Group 2 (TICI 2C/3 = 75%, 2B = 14%), Group 3 (TICI 2C/3 = 89%, 2B = 11%), Group 4 (TICI 2C/3 = 54%, 2B = 33%); p>0.05 between groups. There was no difference in mean number of passes between Group 1(1.890±1.315) vs. Group 2(2.028±1.362).There was no difference in procedure-related complications between groups. Nine patients had arterial dissection - 3 in Group 1, 3 in Group 2, and 3 in Group 4. Two patients were found to have asymptomatic low volume SAH on postoperative CT - both of whom were in Group 4 (p>0.05 vs. Group 1, 2, 3). Postoperative hemorrhagic conversion was similar between groups.ConclusionsDirect aspiration pass technique thrombectomy over large microwires designed for intracranial access is safe and effective with outcomes comparable to traditional techniques in a real world single institutional clinical experience. This could provide potential cost savings and procedural efficiency during mechanical thrombectomy.Disclosures P. Gupta: None. C. Moran: None. A. Chatterjee: None. B. Eby: None. J. Osbun: None. A. Vellimana: 1; C; CV Section/Congress of Neurological Surgeons Foundation, Brain Aneurysm Foundation. 2; C; Penumbra Inc.
IntroductionElective treatment of intracranial aneurysms comprises a large share of neurointerventional practice. With increasing demand for endovascular aneurysm treatment, there is a need to assess ...factors such as operator fatigue and time-related effects that may influence the development of clinical complications, particularly in the elective setting. Here, we review a large cohort of elective treatments to quantify the influence of weekday on post-treatment neuroimaging and occurrence of clinical complications.MethodsClinical and imaging data for elective aneurysms treated endovascularly were retrospectively obtained from a high-volume center and analyzed. Emergent treatments for hemorrhagic or other aneurysms were excluded from analysis. Treatment procedures were classified based on the day of the week they were performed. For each procedure, any post-treatment cerebral angiography, axial neuroimaging, and clinical complications occurring prior to discharge were recorded as a proxy metric for known or suspected complications. To characterize the association between day-of-week and need for imaging or occurrence of complications, univariate analysis using the Chi Square test was performed.ResultsIn total, 1329 elective aneurysm treatments were included in this study. Cerebral angiography was performed after 2.3% (30/1329) of cases, axial neuroimaging was performed after 11.9% (158/1329) of cases, and complications occurred following 5.9% (78/1329) of cases. No trends in need for cerebral angiography were detected in univariate analysis. Need for axial imaging and occurrence of complications were more likely for cases performed on Wednesdays, with 17.4% (49/282) (p = 0.01) of cases needing axial neuroimaging and 9.6% (27/282) (p = 0.024) of cases resulting in clinical complications prior to patient discharge.Abstract E-084 Figure 1ConclusionsOur exploratory analysis demonstrated a higher rate of post-treatment axial neuroimaging and clinical complications for patients electively treated on Wednesdays. While the precise reasons for this trend are unclear, it warrants further investigation to identify practice patterns that may unnecessarily contribute to complications or added cost.Disclosures D. Lauzier: None. S. Cler: None. K. Jayaraman: None. A. Chatterjee: None. J. Osbun: 2; C; Medtronic, Microvention. C. Moran: 2; C; Medtronic, Cerenovus, Microvention, Stryker, Balt. A. Kansagra: 2; C; Microvention, Penumbra.
IntroductionElective treatment of intracranial aneurysms comprises a significant share of neurointerventional practice. Following treatment, patients are typically monitored in the hospital due to ...the risk of acute complications, but the benefits of such monitoring warrant study given the associated cost. Changes in neurologic examination or development of other acute symptoms may prompt workup that often includes cross-sectional imaging, and such imaging can therefore be used as a proxy metric of the need for hospital resources following treatment. Here, we review the frequency, indications, yield, and risk factors for cross-sectional imaging after elective endovascular aneurysm treatment.MethodsClinical and angiographic data from eligible patients were retrospectively assessed for demographics, imaging indications, time of imaging, and imaging findings. Patients were included if they underwent elective aneurysm treatment. Modes of imaging recorded were computerized tomography (CT), magnetic resonance imaging (MRI), angiography, and doppler studies. Plain radiographs were excluded. To quantify the association between potential risk factors and the need for any imaging following elective aneurysm treatment, a multivariate logistic regression was performed. Risk factors included patient demographics, comorbidities, aneurysm morphology, aneurysm size, aneurysm location, number of aneurysms treated, indication for treatment, and treatment type.ResultsIn total, 1418 aneurysms were electively treated in 1329 endovascular procedures. 14.4% (191/1329) of procedures had associated cross-sectional imaging prior to patient discharge. This included 11.9% (158/1329) of cases requiring neuroimaging and 2.6% (35/1329) of cases with other body imaging. The most common indications for imaging were development of symptoms, followed by occurrence of observed intraprocedural events and laboratory abnormalities. Median time from procedure completion to acquisition of post-procedure imaging was 933 minutes (IQR 247–1385) for neuroimaging and 953 minutes (IQR 326–1808) for body imaging. Positive findings were identified after 32.8% (61/158) of cases with neuroimaging performed and 60.0% (21/35) of cases with body imaging performed. In our multivariate analysis, need for any post-treatment imaging prior to discharge was positively associated with a history of cardiovascular disease (p=0.016), larger aneurysms (p=0.008), use of stent-assisted coiling (p=0.016), and use of X or Y stenting (p=0.019).ConclusionsA significant minority of patients received cross-sectional imaging during the hospitalization immediately following elective aneurysm treatment. Risk factors for post-treatment cross-sectional imaging included cardiovascular disease, larger aneurysm size, stent-assisted coiling, and X or Y stenting. These results shed light on the benefits of hospitalization following elective endovascular aneurysm treatment.Disclosures D. Lauzier: None. S. Cler: None. K. Jayaraman: None. A. Chatterjee: None. J. Osbun: 2; C; Medtronic, Microvention. C. Moran: 2; C; Medtronic, Cerenovus, Microvention, Stryker, Balt. A. Kansagra: 2; C; Microvention, Penumbra.
IntroductionStent-assisted coiling of wide neck bifurcation aneurysms in the anterior communicating artery and basilar tip region is performed utilizing various single and multi-stent configurations. ...One common configuration is the Y-stent configuration. While the safety and efficacy of Y-stenting have been studied, risk factors for the need for later Y-stenting remain unknown.Materials and MethodsClinical and angiographic data were retrospectively obtained for patients that underwent stent-assisted coiling at our center. Patients were included in this study if stent-assisted coiling was performed using current generation Neuroform Atlas or LVIS Jr stents. A multivariate logistic regression was performed to measure the influence of aneurysm neck size, aneurysm dome to neck ratio, aneurysm location, and initial stent selection on the need for Y stenting.ResultsStent-assisted coiling was attempted to treat 82 aneurysms in 81 patients during the study period. Technical complications occurred in 7.3% (6/82) of stent-assisted coiling procedures, and clinical complications occurred following 6.1% (5/82) of procedures. In multivariate analysis, larger aneurysm neck size was associated with increased probability of needing Y-stenting (OR 1.85, 95% CI 1.18 - 2.89). No other factors were associated with increased risk of needing Y-stenting for successful stent-assisted coiling.Abstract E-143 Figure 1ConclusionAneurysms with larger neck sizes are more likely to require Y-stenting when treated with stent-assisted coiling. Further study is necessary to optimize stent selection to improve technical feasibility of procedures, reduce procedural times, and minimize procedural costs.Disclosures D. Lauzier: None. B. Root: None. J. Osbun: 2; C; Medtronic, Microvention. A. Chatterjee: None. C. Moran: 2; C; Medtronic, Cerenovus. A. Kansagra: 2; C; Microvention, Penumbra.
IntroductionElective treatment of intracranial aneurysms comprises a large share of neurointerventional practice, with a proliferation of new devices contributing to the tremendous growth of this ...area. Traditionally, endovascular treatment of intracranial aneurysms was limited to coiling and coiling with adjunct strategies. However, the development of flow-diverting stents such as Pipeline and endosaccular devices such as Woven endobridge (WEB) have diversified the treatment options for these aneurysms. Here, we review elective endovascular brain aneurysm treatments over time at a high-volume neurointerventional center.MethodsClinical data and device type for elective aneurysms treatments were retrospectively obtained from a high-volume center from 2002 to 2021. Treatment types recorded included coiling, balloon-assisted coiling, flow diversion, liquid embolization, parent vessel sacrifice, stent-assisted coiling, stent-assisted coiling with an X or Y configuration, and WEB. Gross trends from initial years of analysis were compared to 2019 due to the limitation of elective cases in 2020 due to the ongoing pandemic and an incomplete data set for 2021 due to the timing of data collection. Clinical data and device type for elective aneurysms treatments were retrospectively obtained from a high-volume center from 2002 to 2021. Treatment types recorded included coiling, balloon-assisted coiling, flow diversion, liquid embolization, parent vessel sacrifice, stent-assisted coiling, stent-assisted coiling with an X or Y configuration, and WEB. Gross trends from initial years of analysis were compared to 2019 due to the limitation of elective cases in 2020 due to the ongoing pandemic and an incomplete data set for 2021 due to the timing of data collection.ResultsIn total, 1329 elective aneurysm treatments performed were available for review in the study period. In 2002, 82% of aneurysms were treated with coiling, 13% with balloon coiling, and 5% with parent vessel sacrifice. In 2019, 47% of aneurysms were treated with flow diversion, 17% with stent-assisted coiling, 16% with WEB, and 15% with coiling. Complete overall trends and counts over time are demonstrated in Figure 1.Abstract E-158 Figure 1ConclusionsOur data demonstrates an expected trend of increased flow diversion and endosaccular device use as these treatment options became readily available over time. The availability of these treatments have led to standalone coiling being less frequently pursued.Disclosures D. Lauzier: None. S. Cler: None. K. Jayaraman: None. J. Osbun: 2; C; Medtronic, Microvention. A. Chatterjee: None. C. Moran: 2; C; Medtronic, Cerenovus, Microvention, Stryker, Balt. A. Kansagra: 2; C; Microvention, Penumbra.
IntroductionFlow diversion is commonly used to treat intracranial aneurysms in various regions of the cerebral vasculature, but is only approved for use in the internal carotid arteries. Treatment of ...superior cerebellar artery (SCA) aneurysms with the Pipeline embolization device (PED) is sometimes performed, but has not been well-studied given the rare nature of these aneurysms. These aneurysms are also located in a perforator-rich region, which may influence their response to flow diversion, and makes them distinct from other intracranial aneurysms. Here, we report our experience with flow diversion of distal SCA aneurysms with PED.MethodsClinical and angiographic data of eligible patients was retrospectively obtained and assessed for key demographic characteristics and clinical and angiographic outcomes. Principal outcomes included rates of aneurysm occlusion, clinical complications, technical complication, and later development of in-stent stenosis. Aneurysm occlusion was quantified using the O’Kelly-Marotta scale.ResultsTwo female and 1 male patient underwent flow diversion with PED for treatment of SCA aneurysms. Aneurysm sizes were 5.3 mm, 6.2 mm, and 10.7 mm. All aneurysms were saccular in morphology. Treatment indications were incidental, recent subarachnoid hemorrhage, and recurrence after prior coiling. One technical complication occurred, which was a retained microwire Clinical and angiographic follow-up was available for all patients. Complete aneurysm occlusion was achieved in 0% of cases, but all cases demonstrated angiographic improvement at final follow-up, with 2 instances of subtotal filling and 1 entry remnant observed. Following treatment, 1 patient experienced an ischemic stroke in the territory of the PED, while another experienced a transient ischemic attack in the territory of the PED. One patient had no ischemic complications after flow diversion, but did experience distal migration of the PED on angiographic follow-up.ConclusionWhile our data is preliminary and reflects the uncommon nature of these aneurysms, flow diversion of SCA aneurysms with PED appears to be carry a high risk of clinical complications and a low likelihood of complete aneurysm occlusion. Caution when pursuing flow diversion in these aneurysms is warranted. Further study in larger cohorts is necessary to better define clinical scenarios in which flow diversion or other interventions for SCA aneurysms should be considered.Disclosures D. Lauzier: None. S. Cler: None. J. Osbun: 2; C; Medtronic, Microvention. A. Chatterjee: None. C. Moran: 2; C; Medtronic, Cerenovus, Microvention, Stryker, Balt. A. Kansagra: 2; C; Microvention, Penumbra.
IntroductionFlow diversion of intracranial aneurysms with the Pipeline embolization device (PED) may produce angiographically apparent stenosis within the PED, which can lead to secondary ischemic ...complications. In-stent stenosis can be treated medically with dual antiplatelet therapy (DAPT), but the safety and efficacy of this approach is unknown. In this work, we review the safety and efficacy of DAPT to prevent progression of in-stent stenosis or development of cerebral ischemia.MethodsClinical and angiographic data from eligible patients were assessed from a prospectively maintained neurointerventional database. Details surrounding in-stent stenosis and DAPT were extracted. Patients were included in this study if in-stent stenosis was detected at any angiographic follow-up and managed with DAPT. The primary efficacy endpoint was lack of angiographic progression of in-stent stenosis or new ipsilateral infarct following initiation of medical therapy.ResultsIn total, 23 PED constructs developed in-stent stenosis and were managed with DAPT. Follow-up angiography was available for 19 constructs. 89% (17/19) of PED constructs achieved the primary endpoint of lack of stenosis progression and new ipsilateral ischemic events. Of the two PED constructs that failed to achieve the primary endpoint of this study, one demonstrated worsening of in-stent stenosis from 55% to 76% over 16 months, while the other developed ipsilateral ischemic stroke 4 months after detection of in-stent stenosis. In addition, one patient experienced intracranial hemorrhage 9 months after the initiation of DAPT.Abstract E-185 Figure 1ConclusionsProgression of in-stent stenosis and new ipsilateral ischemic events are limited in the presence of DAPT. However, hemorrhagic events related to DAPT may occasionally occur.Disclosures D. Lauzier: None. S. Cler: None. J. Osbun: 2; C; Medtronic, Microvention. A. Chatterjee: None. C. Moran: 2; C; Medtronic, Cerenovus. A. Kansagra: 2; C; Microvention, Penumbra.
IntroductionThe optimal treatment for tandem large vessel occlusions (TOs) is unclear. This study compared balloon angioplasty plus carotid artery stenting (CAS) versus balloon angioplasty (BA) alone ...for managing TOs.MethodsThis retrospective study analyzed data from the Stroke Thrombectomy and Aneurysm Registry. The primary outcome was the 90-day functional outcome. Secondary outcomes included mortality and degree of revascularization. Safety outcomes included periprocedural complications. Inverse propensity scoring and regression adjustment (IPSWR) addressed non-random treatment selection. To correct for multiple hypothesis testing, especially with significant post-hoc changes, the Sidak (1967) correction to p-values will be utilized and the Sidak-adjusted p (ps) will be reported. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported.ResultsThe study included 244 TO patients, with 132 undergoing CAS and 112 undergoing BA. The CAS group had higher rates of successful reperfusion (95% vs 83.9% ORTUGA, p<0.001) but similar rates of good functional outcome and mortality compared to the BA group. IPSWR found no significant difference between CAS and BA for good functional outcome (ATE -0.13, 95% CI -0.29 to 0.02, p=0.08, ps=0.29), mortality (ATE 0.05, 95% CI -0.06 to 0.15, p=0.37, ps=0.87), or symptomatic ICH (ATE 0.04, 95% CI -0.05 to 0.13, p=0.40, ps=0.85). On Weighted regression, older age (aOR: 0.95, 95% CI 0.91–0.99; p=0.01, ps=0.15) and higher admission NIHSS (aOR: 0.93, 95% CI 0.87–0.99; p=0.02, ps=0.32) were associated with lower odds of functional independence. Intravenous thrombolysis was independently associated with higher odds of symptomatic Intracranial hemorrhage (sICH) (aOR: 6.62 95% CI, 1.44 - 30.5; p=0.02, ps=0.22), but not on its interaction analysis with CAS (aOR: 0.23 95% CI, 0.03 - 1.89; p=0.17, ps=0.95). Alberta Stroke Program Early Computed Tomography scores between 8–10 were associated with lower odds of sICH compared to 0–7 (aOR: 0.22 95% CI, 0.07 - 0.69; p=0.01, ps=0.14).ConclusionThis study found CAS and BA to be comparably safe and effective when combined with mechanical thrombectomy for TOs, but CAS tied to higher sICH from lower ASPECTS and IVT use, leaving uncertainty over the best approach. A limitation of our study is the statistical analysis when accounting for comparisons, mitigated by employing the Sidak-class method, revealing nonsignificant differences and emphasizing comparable functional outcomes between CAS and BA procedures. Nevertheless, further randomized trials are warranted to definitively determine the optimal endovascular approach.DisclosuresM. Essibayi: None. E. Almallouhi: None. M. Anadani: None. R. Medeiros: None. S. Yaghi: 2; C; Nonfunded research collaboration with Medtronic. I. Maier: 6; C; Speakers honoraria from Pfizer and Bristol- Myers Squibb. P. Jabbour: None. J. Kim: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: 1; C; RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of H. 2; C; Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. M. Psychogios: 1; C; Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Gr. 3; C; Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. A. Shaban: None. A. Arthur: 1; C; Balt, Medtronic, Microvention, Penumbra and Siemens. 2; C; Arsenal, Balt, Johnson and Johnson, Medtronic, Microvention, Penumbra, Perfuze, Scientia, Siemens, Stryker. S. Yoshimura: 2; C; Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. B. Howard: None. A. Alawieh: None. I. Fragata: None. H. Cuellar: 2; C; Medtronic, Penumbra and Microvention. A. Polifka: 2; C; Depuy Synthes and Stryker. J. Mascitelli: None. J. Osbun: None. C. Matouk: 1; C; R21NS128641. 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. M. Park: 2; C; Medtronic. M. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker. 2; C; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative; equity interest in Proprio, Cerebrotech, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical. T. Dumont: None. R. Williamson: 2; C; Medtronic, Stryker, and Synaptive Medical. D. Altschul: 1; C; Grant from Bee foundation. 2; C; Microvention. A. Spiotta: 1; C; Research support from Penumbra, Stryker, Medtronic, RapidAI, Avail. 2; C; Penumbra, Stryker, Terumo, and RapidAI. Equity Avail. S. Al Kasab: 1; C; Grant from Stryker for RESCUE-ICAS registry.
Introduction/PurposeFlow diversion of aneurysms located in the M1 segment and middle cerebral artery bifurcation with Pipeline embolization device is sometimes performed, but further study is needed ...to support its regular use in aneurysm treatment. Here, we report measures of safety and efficacy for Pipeline embolization in the proximal middle cerebral artery in a multi-center cohort.Materials and MethodsClinical and angiographic data of eligible patients undergoing Pipeline embolization of aneurysms located in the M1 segment and middle cerebral artery bifurcation were retrospectively obtained from participating centers and assessed for key clinical, angiographic, and cross-sectional imaging outcomes. Additional details were extracted for patients with complications.ResultsIn our multi-center cohort, complete aneurysm occlusion was achieved in 71% (17/24) of treated aneurysms. There were no deaths or disabling strokes, but non-disabling ischemic strokes occurred in 8% (2/24) of patients. For aneurysms in the M1 segment, complete aneurysm occlusion was observed in 75% (12/16) of aneurysms, aneurysm volume reduction was observed in 100% (16/16) of aneurysms, and non-disabling ischemic strokes occurred in 13% (2/16) of patients. An illustrative example of an M1 aneurysm treated with PED is provided in figure 1. For aneurysms at the middle cerebral artery bifurcation, complete aneurysm occlusion was observed in 63% (5/8) of aneurysms, aneurysm volume reduction occurred in 88% (7/8) of aneurysms, and ischemic or hemorrhagic complications occurred in 0% (0/8) of patients. 19% (3/16) of patients that remained asymptomatic in the follow-up period and underwent cross-sectional imaging had clinically silent basal ganglia infarcts identified.Abstract E-078 Figure 1(a) Pre-treatment angiography and (b) pre-treatment 3D reconstruction show a 13.4 x 12.0 mm aneurysm of the right M1 segment. (c) Immediate post-treatment angiography following deployment of 3.25 x 14 mm PED showing contrast stasis within the aneurysm. (d) 32-month follow-up angiography demonstrates complete occlusion of the aneurysmConclusionPipeline embolization of cerebral aneurysms in the M1 segment and middle cerebral artery bifurcation demonstrated a 71% rate of complete aneurysm occlusion. There were no deaths or disabling strokes, but there was an 8% rate of non-disabling ischemic strokes. Further work is necessary to describe the long-term effects of silent basal ganglia infarcts caused by PED.Disclosures D. Lauzier: None. B. Root: None. Y. Kayan: 2; C; Microvention, Penumbra, Medtronic. J. Delgado Almandoz: 2; C; Medtronic, Microvention. J. Osbun: 2; C; Medtronic, Microvention. A. Chatterjee: None. K. Whaley: None. M. Tipps: None. C. Moran: 2; C; Medtronic, Cerenovus. A. Kansagra: 2; C; Penumbra, Microvention, iSchemaView.
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