Radial Artery Access for Treatment of Posterior Circulation Aneurysms Using the Pipeline Embolization Device: Case Series

2019 ◽  
Vol 17 (4) ◽  
pp. 340-347 ◽  
Author(s):  
Eytan Raz ◽  
Maksim Shapiro ◽  
Razvan Buciuc ◽  
Peter Kim Nelson ◽  
Erez Nossek
Keyword(s):  
Case Series ◽  
Vascular Anatomy ◽  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Femoral Access ◽  
Pipeline Embolization Device ◽  
Aneurysm Treatment ◽  
Posterior Circulation Aneurysm ◽  
Device Placement ◽  
Posterior Circulation Aneurysms

AbstractBACKGROUNDThe treatment of selected wide-neck and fusiform posterior circulation aneurysms is challenging for clipping as well as for endovascular route.OBJECTIVETo describe an endovascular approach for vertebral artery aneurysm treatment using transradial access (TRA) instead of the conventional transfemoral access.METHODSWe collected cases from two institutions in which TRA was used for posterior circulation Pipeline Embolization Device (Medtronic, Dublin, Ireland) deployment.RESULTSA total of four patients were treated. TRA was useful in the setting of extreme vessel tortuosity. We utilized 5F Terumo Glidesheath (Terumo Medical, Somerset, New Jersey), intermediate catheter, and a 027 microcatheter for Pipeline deployment. TRA was not associated with any access or deployment difficulties.CONCLUSIONSEarly experience suggests that TRA for Pipeline Embolization Device placement for posterior circulation aneurysm is a safe and efficient alternative to standard transfemoral access. While this approach was initially applied to patients with vascular anatomy that may not allow for safe femoral access or navigation, experience so far argues for considering a radial approach towards some posterior circulation aneurysm treatment.

Commentary: Radial Artery Access for Treatment of Posterior Circulation Aneurysms Using the Pipeline Embolization Device: Case Series

2019 ◽  
Vol 17 (4) ◽  
pp. E139-E140 ◽  
Author(s):  
Matthew T Bender ◽  
Geoffrey P Colby ◽  
Alexander L Coon
Keyword(s):  
Radial Artery ◽  
Case Series ◽  
Posterior Circulation ◽  
Pipeline Embolization Device ◽  
Posterior Circulation Aneurysms

Morbidity and Mortality in Patients With Posterior Circulation Aneurysms Treated With the Pipeline Embolization Device: A Subgroup Analysis of the International Retrospective Study of the Pipeline Embolization Device

Neurosurgery ◽  
2017 ◽  
Vol 83 (3) ◽  
pp. 488-500 ◽  
Author(s):  
Demetrius K Lopes ◽  
Dong-Kyu Jang ◽  
Saruhan Cekirge ◽  
David Fiorella ◽  
Ricardo A Hanel ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Primary Endpoint ◽  
Subgroup Analysis ◽  
Univariate Analysis ◽  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Pipeline Embolization Device ◽  
Aneurysm Size ◽  
Neurological Morbidity ◽  
Posterior Circulation Aneurysms

Abstract BACKGROUND The safety of PipelineTM Embolization Device (PED; Medtronic Inc, Dublin, Ireland) in posterior circulation aneurysms is still controversial. OBJECTIVE To study complications associated with the treatment of posterior circulation aneurysms by conducting a subgroup analysis from the International Retrospective Study of PED registry. METHODS Data from 91 consecutive patients with 95 posterior circulation aneurysms at 17 centers between July 2008 to February 2013 were analyzed. The primary endpoint was defined as any complication leading to neurological morbidity or death. The outcome predictors were calculated using Kaplan–Meier and Cox regression methods. RESULTS The mean aneurysm size was 13.8 mm. Aneurysm types were saccular (36.8%), fusiform (29.5%), dissecting (28.4%), and others (5.3%). The median follow-up was 21.1 mo. Twelve (13.2%) patients encountered a primary endpoint event. In multivariate analysis for the primary endpoint, use of ≥3 PEDs and fusiform shape compared with other shapes had hazard ratios (HRs) of 7.77 (95% confidence interval [CI], 2.48-25.86; P = .0007) and 3.48 (95% CI, 1.06-13.39; P = .0488), respectively. The multivariate HR of aneurysm size for neurological morbidity after PED implantation was 1.11 (95% CI, 1.04-1.18; P = .0015), and HRs of ruptured aneurysm and age for neurological mortality were 8.1 (95% CI, 1.31-41.26; P = .0197) and 1.07 (95% CI, 1.02-1.15; P = .0262), respectively. Basilar artery aneurysm had an HR of 3.54 (95% CI, 1.12-14.18, P = .0529) in the univariate analysis for major outcomes. CONCLUSION PED implantation may be considered for the treatment of posterior circulation aneurysms, especially of saccular or dissecting type. Our major complications appear to be comparable to those reported previously after clipping and coiling in the literature. Neurointerventionists should consider the shape, size, rupture, and location of complex posterior circulation aneurysms as well as age and PED number before the PED placement.

Letter: Commentary: Radial Artery Access for Treatment of Posterior Circulation Aneurysms Using the Pipeline Embolization Device: Case Series

2019 ◽  
Vol 17 (4) ◽  
pp. E186-E187
Author(s):  
Stephanie H Chen ◽  
Marie-Christine Brunet ◽  
Brian T Jankowitz ◽  
Pascal Jabbour ◽  
Eric C Peterson
Keyword(s):  
Radial Artery ◽  
Case Series ◽  
Posterior Circulation ◽  
Pipeline Embolization Device ◽  
Posterior Circulation Aneurysms

scholarly journals Precision microcatheter shaping in vertebrobasilar aneurysm coiling

2019 ◽  
Vol 25 (4) ◽  
pp. 423-429 ◽  
Author(s):  
Katsunari Namba ◽  
Ayuho Higaki ◽  
Naoki Kaneko ◽  
Shigeru Nemoto ◽  
Kensuke Kawai
Keyword(s):  
Intracranial Aneurysm ◽  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Vessel Anatomy ◽  
Vertebrobasilar Artery ◽  
Posterior Circulation Aneurysms ◽  
Vertebrobasilar Aneurysms ◽  
Anatomical Outcomes ◽  
Aneurysm Coiling ◽  
Accuracy And Stability

Background Inventing an optimal curve on a microcatheter is required for successful intracranial aneurysm coiling. Shaping microcatheters for vertebrobasilar artery aneurysm coiling is difficult because of the vessel’s long, tortuous and mobile anatomy. To overcome this problem, we devised a new method of shaping the microcatheter by using the patient’s specific vessel anatomy and the highly shapable microcatheter. We report our preliminary results of treating posterior circulation aneurysms by this method. Methods An unshaped microcatheter (Excelsior XT-17; Stryker Neurovascular, Fremont, CA, USA) was pretreated by exposure to the patient’s vessel for five minutes. The microcatheter was placed in the vicinity of the targeted aneurysm and was left in contact with the patient’s vessel before extraction. This treatment precisely formed a curve on the microcatheter shaft identical to the patient’s vessel anatomy. Following the pretreatment, the tip of the microcatheter was steam shaped according to the long axis of the target aneurysm. Five consecutive vertebrobasilar aneurysms were treated using this shaping method and evaluated for the clinical and anatomical outcomes and microcatheter accuracy and stability. Results All of the designed microcatheters matched the vessel and aneurysm anatomy except in one case that required a single modification. All aneurysms were successfully catheterized without the assistance of a microguidewire, and matched the long axis of the aneurysm. All microcatheters retained stability until the end of the procedure. Conclusions A precise microcatheter shaping for a vertebrobasilar artery aneurysm may be achieved by using the patient’s actual vessel anatomy and the highly shapable microcatheter.

Flow Diversion for Treatment of Intracranial Aneurysms in Pediatric Patients: Multicenter Case Series

Neurosurgery ◽  
2019 ◽  
Vol 87 (1) ◽  
pp. 53-62
Author(s):  
Jacob Cherian ◽  
Visish Srinivasan ◽  
Michael T Froehler ◽  
Jonathan A Grossberg ◽  
C Michael Cawley ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Intracranial Aneurysms ◽  
Case Series ◽  
Flow Diversion ◽  
Pipeline Embolization Device ◽  
Patient Demographics ◽  
Scale Scores ◽  
Treatment Considerations ◽  
Device Placement ◽  
Aneurysm Occlusion

Abstract BACKGROUND Though the Pipeline Embolization Device (Medtronic) is approved for use in adults 22 yr and older, the high efficacy and long-term durability of the device is attractive for treatment of intracranial aneurysms in younger patients who often have aneurysms less amenable to traditional endovascular treatments. OBJECTIVE To report technical, angiographic, and clinical outcomes in patients aged 21 or below undergoing flow-diversion treatment for intracranial aneurysms. METHODS Retrospective review across 16 institutions identified 39 patients aged 21 or below undergoing 46 treatment sessions with Pipeline Embolization Device placement between 2012 and 2018. A total of 50 intracranial aneurysms were treated. Details regarding patient demographics, aneurysm characteristics, treatment considerations, clinical outcomes, and aneurysm occlusion were obtained and analyzed in a multicenter database. RESULTS A total of 70% of patients were male. Nonsaccular morphology was seen in half of identified aneurysms. Six aneurysms were giant, and five patients were treated acutely after ruptured presentation. Eight patients were younger than 10 yr of age. Complete aneurysm occlusion was seen in 74% of treated aneurysms. Three aneurysms (6%) were retreated. A total of 83% of patients had a modified Rankin Scale scores of ≤2 at last clinical follow-up. There were 2 early mortalities (4.3%) in the immediate postprocedure period because of rerupture of a treated ruptured aneurysm. No recanalization of a previously occluded aneurysm was observed. CONCLUSION Flow-diversion treatment is a safe and effective treatment for intracranial aneurysms in patients younger than 22 yr. Rates of complete aneurysm occlusion and adverse events are comparable for rates seen in older patients.

scholarly journals Safety of the Pipeline Embolization Device in Treatment of Posterior Circulation Aneurysms

2012 ◽  
Vol 33 (7) ◽  
pp. 1225-1231 ◽  
Author(s):  
T.J. Phillips ◽  
J.D. Wenderoth ◽  
C.C. Phatouros ◽  
H. Rice ◽  
T.P. Singh ◽  
...  
Keyword(s):  
Posterior Circulation ◽  
Pipeline Embolization Device ◽  
Posterior Circulation Aneurysms

scholarly journals The safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center

2016 ◽  
Vol 125 (1) ◽  
pp. 111-119 ◽  
Author(s):  
Sabareesh K. Natarajan ◽  
Ning Lin ◽  
Ashish Sonig ◽  
Ansaar T. Rai ◽  
Jeffrey S. Carpenter ◽  
...  
Keyword(s):  
Case Series ◽  
Dissecting Aneurysm ◽  
Posterior Circulation ◽  
Flow Diversion ◽  
Single Center Experience ◽  
Vertebrobasilar Artery ◽  
Delayed Hemorrhage ◽  
Posterior Circulation Aneurysms ◽  
Previously Treated

OBJECT Pessimism exists regarding flow diversion for posterior circulation aneurysms because of reports of perforator territory infarcts and delayed ruptures. The authors report the results of patients who underwent Pipeline Embolization Device (PED) flow diversion using novel strategies for treatment of fusiform posterior circulation aneurysms, and compare these results with those from previously reported series. METHODS The authors conducted a retrospective review of data from consecutive patients with fusiform vertebrobasilar artery aneurysms treated with the PED. RESULTS This review resulted in the identification of 12 such patients (mean [± SD] age 55.1 ± 14.1 years). Eleven patients had symptoms; 1 had a dissecting aneurysm identified on imaging for neck pain. The average aneurysm size was 13.25 ± 4.5 mm. None of the aneurysms were ruptured or previously treated. The average clinical follow-up duration was 22.1 ± 10.7 months and radiological follow-up was 14.5 ± 11.1 months from the index PED treatment. One patient suffered a perforator stroke and had a modified Rankin Scale (mRS) score of 4 at last follow-up. Another patient had a retained stent pusher requiring retrieval via surgical cut-down but recovered to an mRS score of 0 at last follow-up. Eleven (91.7%) of 12 patients recovered to an mRS score of 0 or 1. Two patients had aneurysmal remnants at 7 and 10 months, respectively, after the index PED, which were retreated with PEDs. At last follow-up, all 12 aneurysms were occluded and PEDs were patent. The minimum follow-up duration was 12 months from the index PED treatment; no patient experienced delayed hemorrhage, stroke, or in-stent stenosis. CONCLUSIONS Flow diversion with selective adjunctive techniques is evolving to become a safer treatment option for posterior circulation aneurysms. This is the longest clinical follow-up duration reported for a single-center experience of flow-diversion treatment of these aneurysms.

scholarly journals Endoscopic Endonasal Transclival Approach versus Dual Transorbital Port Technique for Clip Application to the Posterior Circulation: A Cadaveric Anatomical and Cerebral Circulation Simulation Study

2016 ◽  
Vol 38 (03) ◽  
pp. 235-244
Author(s):  
Brandon Lucke-Wold ◽  
Aclan Dogan ◽  
Justin Cetas ◽  
William Cameron ◽  
Jeremy Ciporen
Keyword(s):  
Degrees Of Freedom ◽  
Simulation Training ◽  
Vascular Anatomy ◽  
Posterior Circulation ◽  
Vascular Control ◽  
Endoscopic Endonasal ◽  
Neuroendoscopic Surgery ◽  
Clip Application ◽  
Posterior Circulation Aneurysms ◽  
Surgical Teams

Purpose Simulation training offers a useful opportunity to appreciate vascular anatomy and develop the technical expertise required to clip intracranial aneurysms of the posterior circulation. Materials and Methods In cadavers, a comparison was made between the endoscopic transclival approach (ETA) alone and a combined multiportal approach using the ETA and a transorbital precaruncular approach (TOPA) to evaluate degrees of freedom, angles of visualization, and ergonomics of aneurysm clip application to the posterior circulation depending on basilar apex position relative to the posterior clinoids. Results ETA alone provided improved access to the posterior circulation when the basilar apex was high riding compared with the posterior clinoids. ETA + TOPA provided a significantly improved functional working area for instruments and visualization of the posterior circulation for a midlevel basilar apex. A single-shaft clip applier provided improved visualization and space for instruments. Proximal and distal vascular control and feasibility of aneurysmal clipping were demonstrated. Conclusions TOPA is a medial orbital approach to the central skull base; a transorbital neuroendoscopic surgery approach. This anatomical simulation provides surgical teams an alternative to the ETA approach alone to address posterior circulation aneurysms, and a means to preoperatively prepare for intraoperative anatomical and surgical instrumentation challenges.

Use of Pipeline Embolization Device for Posterior Circulation Aneurysms: Single-Center Experiences with Comparison with Anterior Circulation Aneurysms

2018 ◽  
Vol 112 ◽  
pp. e683-e690 ◽  
Author(s):  
Fei Liang ◽  
Yupeng Zhang ◽  
Feng Guo ◽  
Yuxiang Zhang ◽  
Peng Yan ◽  
...  
Keyword(s):  
Posterior Circulation ◽  
Single Center ◽  
Anterior Circulation ◽  
Pipeline Embolization Device ◽  
Posterior Circulation Aneurysms ◽  
Anterior Circulation Aneurysms

Trapped Fourth Ventricle Phenomenon Following Aneurysm Rupture of the Posterior Circulation

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 253-258 ◽  
Author(s):  
Manuel Ferreira ◽  
Brian V. Nahed ◽  
Maya A. Babu ◽  
Brian P. Walcott ◽  
Richard G. Ellenbogen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fourth Ventricle ◽  
Case Series ◽  
Aneurysm Rupture ◽  
Posterior Circulation ◽  
Shunt System ◽  
Cerebrospinal Fluid Diversion ◽  
Isolated Fourth Ventricle ◽  
Posterior Circulation Aneurysms ◽  
Trapped Fourth Ventricle

Abstract BACKGROUND AND IMPORTANCE Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. CLINICAL PRESENTATION A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal cerebrospinal fluid diversion. These patients had no evidence of infection of the cerebrospinal fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal cerebrospinal fluid diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. CONCLUSION Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal cerebrospinal fluid diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.

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