Remodeling of the Posterior Cerebral Artery P1-Segment after Pipeline Flow Diverter Treatment of Posterior Communicating Artery Aneurysms
, Paul Huang 3, Tibor Becske 5,6, Maksim Shapiro 3, Howard Riina 3 and Peter K. Nelson 4
Henry H. Woo
Round 1
Reviewer 1 Report
Very nice proof of a known concept of hemodynamic adaptation following flow diversion in pcom aneurysms. The data are well presented and the text reads very clear.
Just one minor comment, when using multiple PEDs, were these PEDs placed on the same day or were they placed serially after seeing the persistent patency of the treated aneurysm? If serially, was there further decrease in caliber on pcom with more PEDs? Would be interesting to mention this on the paper and comment on how multiple PEDs can affect flow in pcom.
Author Response
"Very nice proof of a known concept of hemodynamic adaptation following flow diversion in pcom aneurysms. The data are well presented and the text reads very clear."
Response: Thank you for this comment.
"Just one minor comment, when using multiple PEDs, were these PEDs placed on the same day or were they placed serially after seeing the persistent patency of the treated aneurysm? If serially, was there further decrease in caliber on pcom with more PEDs? Would be interesting to mention this on the paper and comment on how multiple PEDs can affect flow in pcom. "
Response: Thank you for this comment. I ran an analysis on change of Pcom diameter between single PED (n=7) vs multiple PED (n=7) patients and there was no significant difference in change in Pcom diameter, 0.9 vs 0.6 respectively, p=0.59. In all cases, the pipeline embolization stenting was done in one setting
Reviewer 2 Report
This study clearly demonstrates the efficacy of flow diversion for posterior communicating artery aneurysms with large or even fetal origin posterior cerebral arteries. There is a very high rate of aneurysm occlusion in the series given that fact that there is a branch vessel at the neck of the aneurysm. More importantly, it demonstrates that the cerebrovasculature remodels after flow diversion and that the P1 segment of the ipsilateral circulation will gradually increase in size to accommodate for the gradual progressive decrease in the size of the posterior communicating artery. The concept of slow progressive decrease and increase of the respective vessels involved, "remodeling" is clearly demonstrated in the manuscript. This is a novel concept not necessarily appreciated by many in the Neuroendovascular community and the authors should be lauded for their willingness to share their experience.
Author Response
Thank you for your comments. Much appreciated.
