Pipeline Embolization Device in Treatment of 50 Unruptured Large and Giant Aneurysms

2017 ◽  
Vol 105 ◽  
pp. 232-237 ◽  
Author(s):  
Nimer Adeeb ◽  
Christoph J. Griessenauer ◽  
Hussain Shallwani ◽  
Hakeem Shakir ◽  
Paul M. Foreman ◽  
...  
Keyword(s):  
Pipeline Embolization Device ◽  
Giant Aneurysms ◽  
Large And Giant Aneurysms

scholarly journals Prolapse of the Pipeline embolization device in aneurysms: incidence, management, and outcomes

2017 ◽  
Vol 42 (6) ◽  
pp. E16 ◽  
Author(s):  
Visish M. Srinivasan ◽  
Andrew P. Carlson ◽  
Maxim Mokin ◽  
Jacob Cherian ◽  
Stephen R. Chen ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
The Other ◽  
Anterior Circulation ◽  
Pipeline Embolization Device ◽  
Giant Aneurysms ◽  
Vessel Tortuosity ◽  
Large And Giant Aneurysms ◽  
Anterior Circulation Aneurysms

OBJECTIVEThe Pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, the PED has its own unique technical challenges, including the occurrence of device foreshortening or migration leading to prolapse into the aneurysm. The authors sought to determine the incidence of this phenomenon, the rescue strategies, and outcomes.METHODSFour institutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with PEDs. Patient and aneurysm data as well as angiographic imaging were reviewed for all cases involving device prolapse into the aneurysm.RESULTSA total of 413 intracranial aneurysms were treated with PEDs during the study period, by 5 neurointerventionalists. Large and giant aneurysms (≥ 2 cm) accounted for 32 of these aneurysms. Among these 32 PEDs, prolapse into the aneurysm occurred in 3 patients, with 1 of these PEDs successfully rescued and the other 2 left in situ. No patients suffered any severe complications. The 2 patients in whom the PEDs were left in situ remained on antiplatelet therapy.CONCLUSIONSThe PED may foreshorten or migrate during or after deployment, leading to prolapse into the aneurysm. This phenomenon appears to be associated with large and giant aneurysms, vessel tortuosity, short landing zones, and use of balloon angioplasty. Future study and follow-up is needed to further evaluate this phenomenon, but some of the observations and techniques described in this paper may help to prevent or salvage prolapsed devices.

scholarly journals Coiling of Large and Giant Aneurysms: Complications and Long-Term Results of 334 Cases

2013 ◽  
Vol 35 (3) ◽  
pp. 546-552 ◽  
Author(s):  
N. Chalouhi ◽  
S. Tjoumakaris ◽  
L.F. Gonzalez ◽  
A.S. Dumont ◽  
R.M. Starke ◽  
...  
Keyword(s):  
Long Term Results ◽  
Giant Aneurysms ◽  
Large And Giant Aneurysms

Large and giant aneurysms

1980 ◽  
Vol 3 (1) ◽  
pp. 7-16 ◽  
Author(s):  
H. W. Pia
Keyword(s):  
Giant Aneurysms ◽  
Large And Giant Aneurysms

scholarly journals Off-label uses of the Pipeline embolization device: a review of the literature

2017 ◽  
Vol 42 (6) ◽  
pp. E4 ◽  
Author(s):  
Purvee D. Patel ◽  
Nohra Chalouhi ◽  
Elias Atallah ◽  
Stavropoula Tjoumakaris ◽  
David Hasan ◽  
...  
Keyword(s):  
Flow Diverter ◽  
Pipeline Embolization Device ◽  
Off Label ◽  
Fda Approval ◽  
Posterior Circulation Aneurysms ◽  
Previously Treated ◽  
Large And Giant Aneurysms ◽  
Carotid Cavernous Fistulas ◽  
Small Aneurysms ◽  
Dissecting Aneurysms

The Pipeline embolization device (PED) is the most widely used flow diverter in endovascular neurosurgery. In 2011, the device received FDA approval for the treatment of large and giant aneurysms in the internal carotid artery extending from the petrous to the superior hypophyseal segments. However, as popularity of the device grew and neurosurgeons gained more experience, its use has extended to several other indications. Some of these off-label uses include previously treated aneurysms, acutely ruptured aneurysms, small aneurysms, distal circulation aneurysms, posterior circulation aneurysms, fusiform aneurysms, dissecting aneurysms, pseudoaneurysms, and even carotid-cavernous fistulas. The authors present a literature review of the safety and efficacy of the PED in these off-label uses.

Carotid Balloon Occlusion for Large and Giant Aneurysms: Evaluation of a New Test Occlusion Protocol

Neurosurgery ◽  
2000 ◽  
Vol 47 (1) ◽  
pp. 116-122 ◽  
Author(s):  
Willem Jan J. van Rooij ◽  
Menno Sluzewski ◽  
Nicole H. Metz ◽  
Peter C. G. Nijssen ◽  
Douwe Wijnalda ◽  
...  
Keyword(s):  
Balloon Occlusion ◽  
Giant Aneurysms ◽  
Large And Giant Aneurysms

Carotid Artery Sacrifice for Unclippable and Uncoilable Aneurysms: Endovascular Occlusion Vs Common Carotid Artery Ligation

Neurosurgery ◽  
2010 ◽  
Vol 67 (5) ◽  
pp. 1431-1437 ◽  
Author(s):  
Mohamed Samy Elhammady ◽  
Stacey Quintero Wolfe ◽  
Hamad Farhat ◽  
Mohammad Ali Aziz-Sultan ◽  
Roberto C Heros
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Parent Artery ◽  
Giant Aneurysms ◽  
Presenting Symptoms ◽  
Endovascular Occlusion ◽  
Large And Giant Aneurysms

Abstract BACKGROUND: Optimal treatment of intracranial aneurysms involves complete occlusion of the aneurysm with preservation of the parent artery and all of its branches. Attempts to occlude the aneurysm and preserve the parent artery may be associated with a higher level of risk than parent vessel occlusion or trapping. OBJECTIVE: To evaluate our series of patients with large and giant aneurysms who underwent treatment via endovascular coiling with parent artery sacrifice or surgical ligation of the common carotid artery (CCA) and gain insight into the advantages and risks of each of these alternatives. METHODS: We retrospectively reviewed all patients with aneurysms who underwent carotid sacrifice via endovascular occlusion or surgical CCA ligation during an 8-year period at our institution. RESULTS: Twenty-seven patients with large and giant aneurysms of the internal carotid artery underwent carotid artery sacrifice via endovascular occlusion (n = 15) or CCA ligation (n = 12). Of the patients who underwent endovascular occlusion, 3 developed groin complications, 1 developed a new sixth nerve palsy, 1 died from vasospasm related to subarachnoid hemorrhage, and 1 died secondary to rupture of an associated 3-mm anterior communicating artery aneurysm 5 days postoperatively. Of the patients undergoing CCA ligation, 1 patient developed a partial hypoglossal palsy. Clinical improvement of presenting symptoms was observed in all surviving patients regardless of the method of treatment. Complete aneurysm obliteration was documented in all patients during the initial hospital stay. The mean radiographic long-term follow-up was 14.2 months, which was available in 20 of the 25 surviving patients (80%). Complete obliteration was confirmed at follow-up in all but 2 patients with large cavernous aneurysms; 1 was initially treated with endovascular occlusion and the other with carotid ligation. CONCLUSION: Parent artery sacrifice is still a viable treatment for some complex aneurysms of the internal carotid artery. CCA ligation is a reasonable alternative to endovascular arterial sacrifice.

Management of large and giant aneurysms

1982 ◽  
Vol 5 (4) ◽  
pp. 173-178 ◽  
Author(s):  
R. P. Sengupta
Keyword(s):  
Giant Aneurysms ◽  
Large And Giant Aneurysms

scholarly journals Current Strategies in the Treatment of Intracranial Large and Giant Aneurysms

2021 ◽  
pp. 19-26
Author(s):  
Matthias Gmeiner ◽  
Andreas Gruber
Keyword(s):  
Treatment Strategies ◽  
High Volume ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Active Management ◽  
Definitive Treatment ◽  
Parent Artery ◽  
Giant Aneurysms ◽  
Parent Artery Occlusion ◽  
Large And Giant Aneurysms

AbstractIntroduction: Very large and giant aneurysms are among the most challenging cerebrovascular pathologies in neurosurgery.Methods: The aim of this paper is to review the current literature on the management of very large and giant aneurysms and to describe representative cases illustrating possible treatment strategies.Results: In view of the poor natural history, active management using multiprofessional individualized approaches is required to achieve aneurysm occlusion, relief of mass effect, and obliteration of the embolic source. Both reconstructive (clipping, coiling, stent-assisted coiling, flow diversion [FD]) and deconstructive techniques (parent artery occlusion [PAO], PAO in conjunction with bypass surgery, and strategies of flow modification) are available to achieve definitive treatment with acceptable morbidity.Conclusions: Patients harboring such lesions should be managed at high-volume cerebrovascular centers by multidisciplinary teams trained in all techniques of open and endovascular neurosurgery.

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