Use of Pipeline Flex is associated with reduced fluoroscopy time, procedure time, and technical failure compared with the first-generation Pipeline embolization device

2016 ◽  
Vol 9 (2) ◽  
pp. 188-191 ◽  
Author(s):  
Elizabeth J Le ◽  
Timothy Miller ◽  
Yafell Serulle ◽  
Ravishankar Shivashankar ◽  
Gaurav Jindal ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Radiation Exposure ◽  
Delivery System ◽  
First Generation ◽  
Mean Difference ◽  
Fluoroscopy Time ◽  
Technical Failure ◽  
Procedure Time ◽  
Pipeline Embolization Device ◽  
Aneurysm Treatment

BackgroundFlow diversion with the Pipeline embolization device is a well-established method of intracranial aneurysm treatment. However, deployment of the first-generation device (Pipeline Classic) can be technically challenging. The Pipeline Flex contains the same flow-diverting stent with a modified delivery system.ObjectiveTo compare procedural outcomes between the first-generation device (Pipeline Classic) and the Pipeline Flex.MethodsThirty-eight of the first 40 consecutive patients who underwent intracranial aneurysm treatment with the Pipeline Flex and 58 of the most recent 60 consecutive patients who underwent treatment with the Pipeline Classic at our institution were evaluated. Patient demographics, aneurysm characteristics, technical procedural details, and early outcomes were analyzed.ResultsThe two groups were comparable for age, gender, and location of target aneurysms. Use of Pipeline Flex decreased procedure time by 44.2 min (p≤0.001) and fluoroscopy time by 22.0 min (p=0.001) compared with the Pipeline Classic. Similarly, radiation exposure was less in the Flex group with a mean difference of 3473.5 Gy cm2 (p=0.002), while contrast usage was decreased with a mean difference of 22.3 mL (p=0.007). These differences remained significant in multivariate regression analysis. Finally, the rate of device deployment failure was lower in the Flex group (7.1%) than in the Classic group (23.9%) (p=0.034).ConclusionsUse of Pipeline Flex significantly reduces the total procedure and fluoroscopy time, contrast usage, patient radiation exposure, and proportion of recaptured devices in comparison with the Pipeline Classic, probably owing to an enhanced delivery system that allows for more reliable and controlled deployment.

Pipeline Embolization Device Versus Stent-Assisted Coiling for Intracranial Aneurysm Treatment: A Retrospective Propensity Score-Matched Study

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S17-S17
Author(s):  
Mohamed M Salem ◽  
Krishnan Ravindran ◽  
Alejandro Enriquez-Marulanda ◽  
Luis C Ascanio ◽  
Noah Jordan ◽  
...  
Keyword(s):  
Propensity Score ◽  
Intracranial Aneurysm ◽  
Pipeline Embolization Device ◽  
Aneurysm Treatment ◽  
Matched Study

Feasibility, Safety, and Periprocedural Complications of Pipeline Embolization for Intracranial Aneurysm Treatment Under Conscious Sedation: University at Buffalo Neurosurgery Experience

2015 ◽  
Vol 11 (3) ◽  
pp. 426-430 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Marshall C Cress ◽  
Stephan A Munich ◽  
Ashish Sonig ◽  
Chandan Krishna ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
General Anesthesia ◽  
Radiation Exposure ◽  
Intracranial Aneurysms ◽  
Conscious Sedation ◽  
Contrast Material ◽  
Neurological Complications ◽  
Safe Procedure ◽  
Aneurysm Treatment ◽  
The Mean

Abstract BACKGROUND Endovascular Pipeline Embolization Device (PED) placement for intracranial aneurysms is performed under general anesthesia at most centers because of perceived improved image quality and patient safety. OBJECTIVE To report the feasibility, safety, and outcomes associated with the use of the PED for intracranial aneurysms performed in awake patients after the administration of conscious sedation (CS) and a local anesthetic. METHODS Between March 2012 and September 2014, 130 patients with 139 intracranial aneurysms (8 ruptured) were treated with the PED under CS at our institution. Procedure details and time (including duration, radiation exposure, and fluoroscopy) and procedure-related complications were retrospectively reviewed. RESULTS A total of 155 PED deployment procedures were performed under CS. Treatment was successfully completed in all cases. Anesthesia was converted from CS to general anesthesia during 5 procedures. Mean interval from patient entry at the endovascular suite to procedure initiation was 18 minutes (range, 5 minutes-1 hour 10 minutes). Mean procedure length was 1 hour 25 minutes (range, 30 minutes-3 hours 51 minutes). Mean ± SD values for fluoroscopy time and radiation exposure were 36.17 ± 18.4 minutes and 1367 ± 897 mGy, respectively. The mean amount of contrast material administered was 211.37 ± 83.5 mL. Permanent neurological complications were seen in 4 patients (3%). CONCLUSION In our experience, CS for PED placement for intracranial aneurysm treatment is feasible and safe. Procedure and fluoroscopy times and amount of radiation exposure are similar to or less than described in reports of PED placement under general anesthesia. CS allows direct neurological evaluation and earlier detection of and response to intraprocedural complications.

Transradial cerebral angiography becomes more efficient than transfemoral angiography: lessons from 500 consecutive angiograms

2021 ◽  
pp. neurintsurg-2021-017391
Author(s):  
D Andrew Wilkinson ◽  
Neil Majmundar ◽  
Joshua S Catapano ◽  
Vance L Fredrickson ◽  
Daniel D Cavalcanti ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Cerebral Angiography ◽  
Fluoroscopy Time ◽  
Procedure Time ◽  
Single Center ◽  
Access Site ◽  
Arterial Access ◽  
Diagnostic Angiography ◽  
The Mean ◽  
Intent To Treat

BackgroundTransradial arterial access (TRA) for cerebral diagnostic angiography is associated with fewer access site complications than transfemoral access (TFA). However, concerns about increased procedure time and radiation exposure with TRA may slow its adoption. Our objective was to measure TRA rates of success and fluoroscopy time per vessel after ‘radial-first’ adoption and to compare these rates to those obtained with TFA.MethodsWe examined 500 consecutive cerebral angiograms on an intent-to-treat basis during the first full year of radial-first adoption, recording patient and procedural characteristics and outcomes.ResultsOver a 9-month period at a single center, 457 of 500 angiograms (91.4%) were performed with intent-to-treat via TRA, and 431 cases (86.2%) were ultimately performed via TRA. One patient (0.2%) experienced a temporary neurologic deficit in the TRA group, and none (0%) did in the TFA group (p=0.80). The mean±SD fluoroscopy time per vessel decreased significantly from the first half of the study to the second half for TRA (5.0±3.8 vs 3.4±3.5 min/vessel; p<0.001), while TFA time remained unchanged (3.7±1.8 vs 3.5±1.4 min/vessel; p=0.69). The median fluoroscopy time per vessel for TRA became faster than that for TFA after 150 angiograms.ConclusionOf 500 consecutive angiograms performed during the first full year of radial-first implementation, 86.2% were performed successfully using TRA. TRA efficiency exceeded that of TFA after 150 angiograms. Concerns about the length of procedure or radiation exposure should not be barriers to TRA adoption.

Three-Dimensional Holographic Guidance, Navigation, and Control (3D-GNC) for Endograft Positioning in Porcine Aorta: Feasibility Comparison With 2-Dimensional X-Ray Fluoroscopy

2021 ◽  
pp. 152660282110250
Author(s):  
Karl West ◽  
Sara Al-Nimer ◽  
Vikash R. Goel ◽  
Jeffrey H. Yanof ◽  
Aydan T. Hanlon ◽  
...  
Keyword(s):  
Stent Graft ◽  
Delivery System ◽  
Fluoroscopy Time ◽  
Fluoroscopic Guidance ◽  
Procedure Time ◽  
X Ray ◽  
Landing Zone ◽  
Increased Risk ◽  
Navigation And Control ◽  
And Control

Objectives Intraprocedural deployment of endovascular devices during complex aortic repair with 2-dimensional (2D) x-ray fluoroscopic guidance poses challenges in terms of accurate delivery system positioning and increased risk of x-ray radiation exposure with prolonged fluoroscopy times, particularly in unfavorable anatomy. The objective of this study was to assess feasibility of using an augmented reality (AR) system to position and orient a modified aortic endograft delivery system in comparison with standard fluoroscopy. Materials and Methods The 3-dimensional guidance, navigation, and control (3D-GNC) prototype system was developed for eventual integration with the Intra-Operative Positioning System (IOPS, Centerline Biomedical, Cleveland, OH) to project spatially registered 3D holographic representations of the subject-specific aorta for intraoperative guidance and coupled with an electromagnetically (EM) tracked delivery system for intravascular navigation. Numerical feedback for controlling the endograft landing zone distance and ostial alignment was holographically projected on the operative field. Visualization of the holograms was provided via a commercially available AR headset. A Zenith Spiral-Z AAA limb stent-graft was modified with a scallop, 6 degree-of-freedom EM sensor for tracking, and radiopaque markers for fluoroscopic visualization. In vivo, 10 interventionalists independently positioned and oriented the delivery system to the ostia of renal or visceral branch vessels in anesthetized swine via open femoral artery access using 3D-GNC and standard fluoroscopic guidance. Procedure time, fluoroscopy time, cumulative air kerma, and contrast material volume were recorded for each technique. Positioning and orientation accuracy was determined by measuring the target landing-zone distance error (δLZE) and the scallop-ostium angular alignment error (θSOE) using contrast-enhanced cone beam computed tomography imaging after each positioning for each technique. Mean, standard deviation, and standard error are reported for the performance variables, and Student’s t tests were used to evaluate statistically significant differences in performance mean values of 3D-GNC and fluoroscopy. Results Technical success for the use of 3D-GNC to orient and position the endovascular device at each renal-visceral branch ostium was 100%. 3D-GNC resulted in 56% decrease in procedure time in comparison with standard fluoroscopic guidance (p<0.001). The 3D-GNC system was used without fluoroscopy or contrast-dye administration. Positioning accuracy was comparable for both techniques (p=0.86), while overall orientation accuracy was improved with the 3D-GNC system by 41.5% (p=0.008). Conclusions The holographic 3D-GNC system demonstrated improved accuracy of aortic stent-graft positioning with significant reductions in fluoroscopy time, contrast-dye administration, and procedure time.

Utilising electroanatomic mapping during ablation in patients with CHD to reduce radiation exposure

2021 ◽  
pp. 1-5
Author(s):  
Maryam Rahman ◽  
Jeremy P. Moore ◽  
John Papagiannis ◽  
Grace Smith ◽  
Chris Anderson ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Three Dimensional ◽  
Fluoroscopy Time ◽  
Electroanatomic Mapping ◽  
Complication Rates ◽  
Procedure Time ◽  
Reduce Radiation Exposure ◽  
Three Dimensional Mapping ◽  
Procedural Success

Abstract Background: Patients with CHD can be exposed to high levels of cumulative ionising radiation. Utilisation of electroanatomic mapping during catheter ablation leads to reduced radiation exposure in the general population but has not been well studied in patients with CHD. This study evaluated the radiation sparing benefit of using three-dimensional mapping in patients with CHD. Methods: Data were retrospectively collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy multi-institutional registry. Patients with CHD were selected. Those with previous ablations, concurrent diagnostic or interventional catheterisation and unknown arrhythmogenic foci were excluded. The control cohort was matched for operating physician, arrhythmia mechanism, arrhythmia location, weight and age. The procedure time, rate of fluoroscopy use, fluoroscopy time, procedural success, complications, and distribution of procedures per year were compared between the two groups. Results: Fifty-six patients with congenital heart disease and 56 matched patients without CHD were included. The mean total procedure time was significantly higher in patients with CHD (212.6 versus 169.5 minutes, p = 0.003). Their median total fluoroscopy time was 4.4 minutes (compared to 1.8 minutes), and their rate of fluoroscopy use was 23% (compared to 13%). The acute success and minor complication rates were similar and no major complications occurred. Conclusions: With the use of electroanatomic mapping during catheter ablation, fluoroscopy use can be reduced in patients with CHD. The majority of patients with CHD received zero fluoroscopy.

Abstract P508: Transradial Cerebral Angiography Becomes More Efficient Than Transfemoral; Lessons From 500 Consecutive Angiograms

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
D. Andrew Wilkinson ◽  
Neil Majmundar ◽  
Joshua Catapano ◽  
Daniel Cavalcanti ◽  
Vance Frederickson ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Cerebral Angiography ◽  
Fluoroscopy Time ◽  
Procedure Time ◽  
Single Center ◽  
Access Site ◽  
Arterial Access ◽  
Performance Time ◽  
Initial Learning ◽  
Diagnostic Angiography

Introduction: Transradial arterial access (TRA) for cerebral diagnostic angiography (DSA) is associated with reduced access-site complications compared with transfemoral access (TFA), though concerns about increased procedure time and radiation exposure may slow its adoption. Objective: To examine “radial-first” cerebral angiography by measuring TRA rates of success and fluoroscopy time and comparing to TFA. Methods: We examined 500 consecutive cerebral angiograms during the first full year of “radial-first” adoption, recording patient and procedural characteristics including intended and performed access sites, fluoroscopy time per vessel catheterized, and outcomes of the procedure. Results: Of 500 angiograms done over a nine-month period at a single center, 431 (86.2%) of cases were successfully performed via TRA. There was one case of temporary neurologic deficit in the TRA group, and none in the TFA group (n=1, 0.2% TRA vs. n=0, 0.05 TFA, p=0.8). Vascular access-site complications were lower in the TRA group than TFA (n=2, 0.4% TRA vs. n=2, 4.7% TFA, p=0.04). There was no difference in the number of cases successfully performed via TRA in the first half of the study compared with the second (n=215, 86.0% vs. n=216, 86.4%, p=0.90). Fluoroscopy time decreased from the first half of the study to the second half for TRA performance(5.0±3.9 min/vessel vs. 3.4±3.5 min/vessel, p<0.001), while TFA performance time remained unchanged (3.7±1.8 min/vessel vs. 3.5±1.4 min/vessel, p=0.69). The median fluoroscopy time for TRA became faster than TFA after 150 angiograms. Conclusions: Among angiograms performed during the first full year of “radial first” implementation, 86% were performed successfully using TRA. TRA efficiency continued to improve beyond the initial learning curve, exceeding that of TFA after 150 angiograms. Concerns about length of procedure or radiation exposure should not be barriers to TRA adoption.

scholarly journals Radiation exposure in endovascular stroke treatment of acute basilar artery occlusions—a matched-pair analysis

2020 ◽  
Vol 62 (12) ◽  
pp. 1701-1707
Author(s):  
Charlotte S. Weyland ◽  
Arne Potreck ◽  
Ulf Neuberger ◽  
Markus A. Möhlenbruch ◽  
Simon Nagel ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Fluoroscopy Time ◽  
Matched Pair ◽  
Procedure Time ◽  
Stroke Treatment ◽  
Dose Area Product ◽  
Matched Pair Analysis

Abstract Purpose To determine the radiation exposure in endovascular stroke treatment (EST) of acute basilar artery occlusions (BAO) and compare it with radiation exposure of EST for embolic middle cerebral artery occlusions (MCAO). Methods In this retrospective analysis of an institutional review board−approved prospective stroke database of a comprehensive stroke center, we focused on radiation exposure (as per dose area product in Gy × cm2, median (IQR)), procedure time, and fluoroscopy time (in minutes, median [IQR]) in patients receiving EST for BAO. Patients who received EST for BAO were matched case by case with patients who received EST for MCAO according to number of thrombectomy attempts, target vessel reperfusion result, and thrombectomy technique. Results Overall 180 patients (n = 90 in each group) were included in this analysis. General anesthesia was conducted more often during EST of BAO (BAO: 75 (83.3%); MCAO: 18 (31.1%), p < 0.001). Procedure time (BAO: 31 (20–43); MCAO: 27 (18–38); p value 0.226) and fluoroscopy time (BAO: 29 (20–59); MCAO: 29 (17–49), p value 0.317) were comparable. Radiation exposure was significantly higher in patients receiving EST for BAO (BAO: 123.4 (78.7–204.2); MCAO: 94.3 (65.5–163.7), p value 0.046), which represents an increase by 23.7%. Conclusion Endovascular stroke treatment of basilar artery occlusions is associated with a higher radiation exposure compared with treatment of middle cerebral artery occlusions.

Versatile use of catheter systems for deployment of the Pipeline embolization device: a comparison of biaxial and triaxial catheter systems

2020 ◽  
Vol 12 (6) ◽  
pp. 585-590
Author(s):  
Kunal Vakharia ◽  
Muhammad Waqas ◽  
Hakeem J Shakir ◽  
Felix Chin ◽  
Joelle N Hartke ◽  
...  
Keyword(s):  
Fluoroscopy Time ◽  
Complication Rates ◽  
Procedure Time ◽  
Pipeline Embolization Device ◽  
Access System ◽  
Guide Catheter ◽  
Scale Scores ◽  
Deployment Time ◽  
Patient Radiation Exposure

BackgroundA Pipeline embolization device (PED; Medtronic, Dublin, Ireland) can be deployed using either a biaxial or a triaxial catheter delivery system.ObjectiveTo compare the use of these two catheter delivery systems for intracranial aneurysm treatment with the PED.MethodsA retrospective study of patients undergoing PED deployment with biaxial or triaxial catheter systems between 2014 and 2016 was conducted. Experienced neurointerventionalists performed the procedures. Patients who received multiple PEDs or adjunctive coils were excluded. The two groups were compared for PED deployment time, total fluoroscopy time, patient radiation exposure, complications, and cost.ResultsEighty-two patients with 89 intracranial aneurysms were treated with one PED each. In 49 cases, PEDs were deployed using biaxial access; triaxial access was used in 33 cases. Time (min) from guide catheter run to PED deployment was significantly shorter in the biaxial group (24.0±18.7 vs 38.4±31.1, P=0.006) as was fluoroscopy time (28.8±23.0 vs 50.3±27.1, P=0.001). Peak radiation skin exposure (mGy) in the biaxial group was less than in the triaxial group (1243.7±808.2 vs 2074.6±1505.6, P=0.003). No statistically significant differences were observed in transient and permanent complication rates or modified Rankin Scale scores at 30 days. The triaxial access system cost more than the biaxial access system (average $3285 vs $1790, respectively). Occlusion rates at last follow-up (mean 6 months) were similar between the two systems (average 88.1%: biaxial, 89.2%: triaxial).ConclusionOur results indicate near-equivalent safety and effectiveness between biaxial and triaxial approaches. Some reductions in cost and procedure time were noted with the biaxial system.

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