Early angiographic response to Pipeline Vantage flow diverter embolization of intracranial carotid aneurysms.

Abstract

Background: The Pipeline Vantage 027 flow diverter became available a year ago in the United States. We report an observational study of its safety and early angiographic response in the treatment of internal carotid artery (ICA) aneurysms.

Methods: All patients treated with the Vantage 027 for ICA aneurysms from April to November 2024 at a single center were included. Intraprocedural contrast-enhanced cone-beam CT was used to evaluate vessel wall apposition. A novel proximal ledge deformity is defined as delayed elevation of one stent edge into the lumen while the opposite edge remains wall-apposed.

Results: Twenty-four aneurysms (mean size 4.2±2.7 mm) in 20 patients underwent Vantage 027 embolization. Clinical follow-up at 6 months revealed no major/minor stroke and a single reversible ischemic attack following dual anti-platelet therapy (DAPT) non-compliance. Follow-up angiography in all patients revealed complete occlusion in 19/24 aneurysms at a median of 3.5 months (79%). Severe ≥50% stenosis was noted in 7/20 (35%) with distal fishmouth deformity in 12/20 (60%); both fishmouthing (p=0.003) and severe stenosis (p=0.04) were associated with younger age. We also observed a proximal ledge in 5/20 (25%) with luminal caliber compromise.

Conclusions: Although Vantage 027 ICA aneurysm embolization resulted in early robust aneurysm involution, it was associated with an age-dependent fishmouthing braid deformity and a proximal ledge deformity possibly requiring extended DAPT. These results encourage further analysis of the vascular response to Vantage 027 and similar stents.