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<meta name="DC.Title" content="Modifying Flow in the ICA Bifurcation: Pipeline Deployment from the Supraclinoid ICA Extending into the M1 Segment—Clinical and Anatomic Results" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4013" />
<meta name="DC.Date" content="2014-11-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2014 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Utility of the Pipeline Embolization Device extending to the M1 and its clinical and flow consequences at the ICA bifurcation have not been characterized. We analyzed flow modification in cases where a single Pipeline Embolization Device was deployed from the M1 to the distal supraclinoid ICA, covering the A1, for aneurysm treatment.

MATERIALS AND METHODS: A1 flow modifications and size regression in postprocedure and follow-up angiography were analyzed. Vessel diameters and ratios of the proximal A1 and M1 segments and the distal ICA were assessed. Relationships between Pipeline Embolization Device nominal diameter and the vessel diameters at landing zones were obtained. Clinical assessments after flow modification were documented.

RESULTS: Six of 7 patients demonstrated no change of flow in the anterior cerebral artery/anterior communicating artery complex at immediate postembolization angiography. All patients who underwent follow-up angiography demonstrated size regression of the ipsilateral A1. Midterm follow-up angiography revealed complete reversal of flow in the ipsilateral A1 in 4 of 5 patients. One patient did not demonstrate flow modification. This patient had a dominant ipsilateral A1. Vessel ratios in this case demonstrated a unique configuration in favor of maintaining patency of the ipsilateral A1. There were no clinical or radiographic signs of ischemia. One patient experienced asymptomatic angiographic in-stent stenosis at the M1.

CONCLUSIONS: We found that deployment of a Pipeline Embolization Device from the distal supraclinoid ICA to the M1 may result in reversal of flow in the anterior cerebral artery/anterior communicating artery complex and regression of the ipsilateral A1. Preoperative anatomic quantitation and sizing of the Pipeline Embolization Device may predict flow modification results.

ACA
:   anterior cerebral artery
AchoA
:   anterior choroidal artery
AcomA
:   anterior communicating artery
FD
:   flow diverter
ICAb
:   internal carotid artery bifurcation
OphA
:   ophthalmic artery
PED
:   Pipeline Embolization Device" />
<meta name="DC.Contributor" content="E. Nossek" />
<meta name="DC.Contributor" content="D.J. Chalif" />
<meta name="DC.Contributor" content="S. Chakraborty" />
<meta name="DC.Contributor" content="A. Setton" />
<meta name="article:published_time" content="2014-11-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Modifying Flow in the ICA Bifurcation: Pipeline Deployment from the Supraclinoid ICA Extending into the M1 Segment—Clinical and Anatomic Results" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Utility of the Pipeline Embolization Device extending to the M1 and its clinical and flow consequences at the ICA bifurcation have not been characterized. We analyzed flow modification in cases where a single Pipeline Embolization Device was deployed from the M1 to the distal supraclinoid ICA, covering the A1, for aneurysm treatment.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A1 flow modifications and size regression in postprocedure and follow-up angiography were analyzed. Vessel diameters and ratios of the proximal A1 and M1 segments and the distal ICA were assessed. Relationships between Pipeline Embolization Device nominal diameter and the vessel diameters at landing zones were obtained. Clinical assessments after flow modification were documented.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Six of 7 patients demonstrated no change of flow in the anterior cerebral artery/anterior communicating artery complex at immediate postembolization angiography. All patients who underwent follow-up angiography demonstrated size regression of the ipsilateral A1. Midterm follow-up angiography revealed complete reversal of flow in the ipsilateral A1 in 4 of 5 patients. One patient did not demonstrate flow modification. This patient had a dominant ipsilateral A1. Vessel ratios in this case demonstrated a unique configuration in favor of maintaining patency of the ipsilateral A1. There were no clinical or radiographic signs of ischemia. One patient experienced asymptomatic angiographic in-stent stenosis at the M1.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;We found that deployment of a Pipeline Embolization Device from the distal supraclinoid ICA to the M1 may result in reversal of flow in the anterior cerebral artery/anterior communicating artery complex and regression of the ipsilateral A1. Preoperative anatomic quantitation and sizing of the Pipeline Embolization Device may predict flow modification results.&lt;/p&gt;" />
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<meta name="citation_author" content="E. Nossek" />
<meta name="citation_author_institution" content="aFrom the Department of Neurosurgery, Hofstra North Shore–Long Island Jewish School of Medicine and North Shore–Long Island Jewish Health System, Manhasset, New York." />
<meta name="citation_author" content="D.J. Chalif" />
<meta name="citation_author_institution" content="aFrom the Department of Neurosurgery, Hofstra North Shore–Long Island Jewish School of Medicine and North Shore–Long Island Jewish Health System, Manhasset, New York." />
<meta name="citation_author" content="S. Chakraborty" />
<meta name="citation_author_institution" content="aFrom the Department of Neurosurgery, Hofstra North Shore–Long Island Jewish School of Medicine and North Shore–Long Island Jewish Health System, Manhasset, New York." />
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<meta name="citation_author_institution" content="aFrom the Department of Neurosurgery, Hofstra North Shore–Long Island Jewish School of Medicine and North Shore–Long Island Jewish Health System, Manhasset, New York." />
<meta name="citation_reference" content="citation_journal_title=Neuroradiology;citation_journal_abbrev=Neuroradiology;citation_title=Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications-a retrospective data analysis.;citation_pages=1145-1152;citation_volume=54;citation_year=2012;citation_issue=10;citation_pmid=22569955;citation_doi=10.1007/s00234-012-1047-3" />
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<meta name="twitter:title" content="Modifying Flow in the ICA Bifurcation: Pipeline Deployment from the Supraclinoid ICA Extending into the M1 Segment—Clinical and Anatomic Results" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Utility of the Pipeline Embolization Device extending to the M1 and its clinical and flow consequences at the ICA bifurcation have not been characterized. We analyzed flow modification in cases where a single Pipeline Embolization Device was deployed from the M1 to the distal supraclinoid ICA, covering the A1, for aneurysm treatment.

MATERIALS AND METHODS: A1 flow modifications and size regression in postprocedure and follow-up angiography were analyzed. Vessel diameters and ratios of the proximal A1 and M1 segments and the distal ICA were assessed. Relationships between Pipeline Embolization Device nominal diameter and the vessel diameters at landing zones were obtained. Clinical assessments after flow modification were documented.

RESULTS: Six of 7 patients demonstrated no change of flow in the anterior cerebral artery/anterior communicating artery complex at immediate postembolization angiography. All patients who underwent follow-up angiography demonstrated size regression of the ipsilateral A1. Midterm follow-up angiography revealed complete reversal of flow in the ipsilateral A1 in 4 of 5 patients. One patient did not demonstrate flow modification. This patient had a dominant ipsilateral A1. Vessel ratios in this case demonstrated a unique configuration in favor of maintaining patency of the ipsilateral A1. There were no clinical or radiographic signs of ischemia. One patient experienced asymptomatic angiographic in-stent stenosis at the M1.

CONCLUSIONS: We found that deployment of a Pipeline Embolization Device from the distal supraclinoid ICA to the M1 may result in reversal of flow in the anterior cerebral artery/anterior communicating artery complex and regression of the ipsilateral A1. Preoperative anatomic quantitation and sizing of the Pipeline Embolization Device may predict flow modification results.

ACA
:   anterior cerebral artery
AchoA
:   anterior choroidal artery
AcomA
:   anterior communicating artery
FD
:   flow diverter
ICAb
:   internal carotid artery bifurcation
OphA
:   ophthalmic artery
PED
:   Pipeline Embolization Device" />
<meta name="og-title" property="og:title" content="Modifying Flow in the ICA Bifurcation: Pipeline Deployment from the Supraclinoid ICA Extending into the M1 Segment—Clinical and Anatomic Results" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/35/11/2125" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Utility of the Pipeline Embolization Device extending to the M1 and its clinical and flow consequences at the ICA bifurcation have not been characterized. We analyzed flow modification in cases where a single Pipeline Embolization Device was deployed from the M1 to the distal supraclinoid ICA, covering the A1, for aneurysm treatment.

MATERIALS AND METHODS: A1 flow modifications and size regression in postprocedure and follow-up angiography were analyzed. Vessel diameters and ratios of the proximal A1 and M1 segments and the distal ICA were assessed. Relationships between Pipeline Embolization Device nominal diameter and the vessel diameters at landing zones were obtained. Clinical assessments after flow modification were documented.

RESULTS: Six of 7 patients demonstrated no change of flow in the anterior cerebral artery/anterior communicating artery complex at immediate postembolization angiography. All patients who underwent follow-up angiography demonstrated size regression of the ipsilateral A1. Midterm follow-up angiography revealed complete reversal of flow in the ipsilateral A1 in 4 of 5 patients. One patient did not demonstrate flow modification. This patient had a dominant ipsilateral A1. Vessel ratios in this case demonstrated a unique configuration in favor of maintaining patency of the ipsilateral A1. There were no clinical or radiographic signs of ischemia. One patient experienced asymptomatic angiographic in-stent stenosis at the M1.

CONCLUSIONS: We found that deployment of a Pipeline Embolization Device from the distal supraclinoid ICA to the M1 may result in reversal of flow in the anterior cerebral artery/anterior communicating artery complex and regression of the ipsilateral A1. Preoperative anatomic quantitation and sizing of the Pipeline Embolization Device may predict flow modification results.

ACA
:   anterior cerebral artery
AchoA
:   anterior choroidal artery
AcomA
:   anterior communicating artery
FD
:   flow diverter
ICAb
:   internal carotid artery bifurcation
OphA
:   ophthalmic artery
PED
:   Pipeline Embolization Device" />
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    <title>Modifying Flow in the ICA Bifurcation: Pipeline Deployment from the Supraclinoid ICA Extending into the M1 Segment—Clinical and Anatomic Results | American Journal of Neuroradiology</title>  
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      <h1 class="highwire-cite-title" id="page-title">Modifying Flow in the ICA Bifurcation: Pipeline Deployment from the Supraclinoid ICA Extending into the M1 Segment—Clinical and Anatomic Results</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">E. Nossek</span>, <span class="highwire-citation-author" data-delta="1">D.J. Chalif</span>, <span class="highwire-citation-author" data-delta="2">S. Chakraborty</span> and <span class="highwire-citation-author" data-delta="3">A. Setton</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">November 2014,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">35 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2125-2129; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4013 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-13769--6892377286" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">E. Nossek </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery, Hofstra North Shore–Long Island Jewish School of Medicine and North Shore–Long Island Jewish Health System, Manhasset, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BNossek%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nossek%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.%2BNossek%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">D.J. Chalif </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery, Hofstra North Shore–Long Island Jewish School of Medicine and North Shore–Long Island Jewish Health System, Manhasset, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.J.%2BChalif%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chalif%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.J.%2BChalif%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">S. Chakraborty </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery, Hofstra North Shore–Long Island Jewish School of Medicine and North Shore–Long Island Jewish Health System, Manhasset, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BChakraborty%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chakraborty%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BChakraborty%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">A. Setton </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery, Hofstra North Shore–Long Island Jewish School of Medicine and North Shore–Long Island Jewish Health System, Manhasset, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BSetton%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Setton%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.%2BSetton%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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<p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Utility of the Pipeline Embolization Device extending to the M1 and its clinical and flow consequences at the ICA bifurcation have not been characterized. We analyzed flow modification in cases where a single Pipeline Embolization Device was deployed from the M1 to the distal supraclinoid ICA, covering the A1, for aneurysm treatment.</p>
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<p id="p-2"><strong>MATERIALS AND METHODS:</strong> A1 flow modifications and size regression in postprocedure and follow-up angiography were analyzed. Vessel diameters and ratios of the proximal A1 and M1 segments and the distal ICA were assessed. Relationships between Pipeline Embolization Device nominal diameter and the vessel diameters at landing zones were obtained. Clinical assessments after flow modification were documented.</p>
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<div id="sec-3" class="subsection">

<p id="p-3"><strong>RESULTS:</strong> Six of 7 patients demonstrated no change of flow in the anterior cerebral artery/anterior communicating artery complex at immediate postembolization angiography. All patients who underwent follow-up angiography demonstrated size regression of the ipsilateral A1. Midterm follow-up angiography revealed complete reversal of flow in the ipsilateral A1 in 4 of 5 patients. One patient did not demonstrate flow modification. This patient had a dominant ipsilateral A1. Vessel ratios in this case demonstrated a unique configuration in favor of maintaining patency of the ipsilateral A1. There were no clinical or radiographic signs of ischemia. One patient experienced asymptomatic angiographic in-stent stenosis at the M1.</p>
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<div id="sec-4" class="subsection">

<p id="p-4"><strong>CONCLUSIONS:</strong> We found that deployment of a Pipeline Embolization Device from the distal supraclinoid ICA to the M1 may result in reversal of flow in the anterior cerebral artery/anterior communicating artery complex and regression of the ipsilateral A1. Preoperative anatomic quantitation and sizing of the Pipeline Embolization Device may predict flow modification results.</p>
</div></div><div class="section glossary" id="glossary-1">
<h2>ABBREVIATIONS:</h2>
<dl id="def-list-1"><dt id="def-item-1">ACA<span class="def-item-dt-sep"></span></dt><dd>anterior cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">AchoA<span class="def-item-dt-sep"></span></dt><dd>anterior choroidal artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">AcomA<span class="def-item-dt-sep"></span></dt><dd>anterior communicating artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">FD<span class="def-item-dt-sep"></span></dt><dd>flow diverter<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">ICAb<span class="def-item-dt-sep"></span></dt><dd>internal carotid artery bifurcation<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">OphA<span class="def-item-dt-sep"></span></dt><dd>ophthalmic artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">PED<span class="def-item-dt-sep"></span></dt><dd>Pipeline Embolization Device</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2014 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/35/11/2125.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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      <div class="highwire-cite-title">Modifying Flow in the ICA Bifurcation: Pipeline Deployment from the Supraclinoid ICA Extending into the M1 Segment—Clinical and Anatomic Results</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Nossek</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">D.J.</span> <span class="nlm-surname">Chalif</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Chakraborty</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Setton</span></span></span></div>
  
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      <div class="highwire-cite-title">Modifying Flow in the ICA Bifurcation: Pipeline Deployment from the Supraclinoid ICA Extending into the M1 Segment—Clinical and Anatomic Results</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Nossek</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">D.J.</span> <span class="nlm-surname">Chalif</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Chakraborty</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Setton</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2014, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">35 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2125-2129; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4013 </span></div>
  
  
  
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