Republished: Novel balloon application for rescue and realignment of a proximal end migrated pipeline flex embolization device into the aneurysmal sac: complication management

2016 ◽  
Vol 9 (1) ◽  
pp. e4-e4 ◽  
Author(s):  
Mario Martínez-Galdámez ◽  
Joaquin Ortega-Quintanilla ◽  
Antonio Hermosín ◽  
Eduardo Crespo-Vallejo ◽  
Juan José Ailagas ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Stent Migration ◽  
Complication Management ◽  
Potential Complication ◽  
Luminal Diameter ◽  
Pipeline Embolization Device ◽  
Balloon Technique ◽  
Large Aneurysm ◽  
Flow Diverting Stent

The pipeline embolization device (PED) has become a routine firstline option for the treatment of an increasing population of intracranial aneurysms at many neurovascular centers. Intraprocedural complications during PED deployment, or complications associated with migration of the device, are rarely reported problems. Significant mismatch in luminal diameter between the inflow vessel and the outflow vessel or excessive dragging–stretching of the PED have been related to ‘watermelon seed’ or ‘accordion’ effects, respectively, resulting in stent migration. Here we present a novel balloon technique that was successfully used to realign an in situ flow diverting stent that had prolapsed into a large aneurysm. This represents a useful salvage technique and should be considered when encountering this potential complication.

scholarly journals A Case of Migration of Pipeline Embolization Device Causing Rupture during Treatment of an Unruptured Vertebral Artery Dissecting Aneurysm

2021 ◽  
Vol 27 (2) ◽  
pp. 110-113
Author(s):  
Sung Ho Kim ◽  
Dong Kyu Yeo ◽  
Gwang Soo Lee
Keyword(s):  
Vertebral Artery ◽  
Intracranial Aneurysms ◽  
Rare Complication ◽  
Stent Migration ◽  
Dissecting Aneurysm ◽  
Potential Complication ◽  
Pipeline Embolization Device ◽  
New Treatment ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Perforating Arteries

Endoluminal reconstruction of an intracranial aneurysm using flow-diverting devices, such as the pipeline embolization device (PED), is a new treatment modality with good clinical outcomes. The device was originally indicated for challenging cases, such as wide-necked large or giant aneurysms, and is gaining popularity as a reliable treatment for nearly all intracranial aneurysms. The overall complication rate of flow-diverting devices use is 17.0%, including occlusion of side-branching or perforating arteries, rerupture of the aneurysm, in-stent thrombosis, and, rarely, stent migration. We report a rare complication of the PED: delayed migration of the PED after successful stent implantation during treatment of an unruptured vertebral artery dissecting aneurysm, which resulted in rupture of the aneurysm. Further, we discuss technical steps that can be taken to prevent this potential complication.

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 Malignant stroke in a ticagrelor non-responder as a complication following aneurysm treatment with the Pipeline Embolization Device™

2017 ◽  
Vol 23 (3) ◽  
pp. 297-300 ◽  
Author(s):  
Pegah Ghamasaee ◽  
Kevin Carr ◽  
Jeremiah Johnson ◽  
Ramesh Grandhi
Keyword(s):  
Active Metabolite ◽  
Intracranial Aneurysms ◽  
Interventional Procedures ◽  
Internal Carotid ◽  
Dual Antiplatelet Therapy ◽  
Pipeline Embolization Device ◽  
Adp Receptor ◽  
Ischemic Events ◽  
Neurointerventional Procedures ◽  
Flow Diverting Stent

The Pipeline Embolization Device™ (PED; Covidien Neurovascular Inc, Irvine, CA, USA) is a flow-diverting stent often used for the endovascular treatment of large or giant, wide-necked intracranial aneurysms of the internal carotid artery. Because of the inherent thrombogenicity of intracranial stents, dual-antiplatelet therapy is initiated after placement, which has been shown to decrease morbidity and mortality related to perioperative ischemic events in neurointerventional procedures. However, in some series, as much as 50% of patients demonstrate clopidogrel non-responsiveness. In these non-responders, alternate agents such as ticagrelor can be used to achieve adequate anticoagulation. Compared with clopidogrel, a prodrug requiring Cytochrome P450 enzymolysis for activation, ticagrelor directly and reversibly inhibits the P2Y12 ADP receptor. The absorption of the prodrug and the formation of its active metabolite is comparatively quicker ( tmax 1.3–2 hours; 1.5–3 hours, respectively). To date, there have been no documented cases of ticagrelor non-responsiveness involving patients undergoing placement of flow-diverting stents or other endovascular neuro-interventional procedures.

scholarly journals The Pipeline Flow-Diverting Stent for Exclusion of Ruptured Intracranial Aneurysms With Difficult Morphologies

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons21-ons28 ◽  
Author(s):  
Allan R. Martin ◽  
Juan Pablo Cruz ◽  
Charles C. Matouk ◽  
Julian Spears ◽  
Thomas R. Marotta
Keyword(s):  
Intracranial Aneurysms ◽  
Primary Treatment ◽  
Therapeutic Tool ◽  
Pipeline Embolization Device ◽  
The Third ◽  
Ruptured Aneurysms ◽  
Pipeline Flow ◽  
Ruptured Intracranial Aneurysms ◽  
Flow Diverting Stent ◽  
Viable Treatment

Abstract BACKGROUND: The Pipeline Embolization Device (PED) is a flow-diverting stent that may represent a new therapeutic tool for difficult-to-treat intracranial aneurysms, including those that present with subarachnoid hemorrhage (SAH). OBJECTIVE: To demonstrate the feasibility of utilizing the PED as a primary treatment for ruptured aneurysms with challenging morphologies. METHODS: Three patients with ruptured intracranial aneurysms presented with SAH. Three distinct and difficult-to-treat aneurysm morphologies were encountered: (1) a small basilar trunk pseudoaneurysm, (2) a carotid artery blister aneurysm, and (3) an A1/A2 junction-dissecting-type aneurysm. All were treated with deployment of one or more PEDs across the aneurysm. RESULTS: PEDs were successfully deployed in all 3 cases. Two patients were treated with 2 overlapping PEDs, and the third patient was treated with a single device. Aneurysm obliteration was achieved in all 3 cases with no early rehemorrhage or other clinically adverse event. CONCLUSION: Endovascular treatment with the pipeline flow-diverting stent may be a viable treatment option for otherwise difficult-to-treat aneurysm morphologies in the context of acute SAH.

Solitaire FR Stent as an Adjunctive Tool for Pipeline Stent Deployment in the Treatment of Giant Intracranial Aneurysms

2012 ◽  
Vol 72 (2) ◽  
pp. ons241-ons244
Author(s):  
Frédéric Clarençon ◽  
Gerald Wyse ◽  
Noel Fanning ◽  
Federico Di Maria ◽  
André Gaston ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Giant Aneurysm ◽  
Parent Artery ◽  
Stent Deployment ◽  
Pipeline Embolization Device ◽  
Unruptured Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Solitaire Fr ◽  
Pipeline Stent ◽  
Flow Diverting Stent

Abstract BACKGROUND AND IMPORTANCE: The use of flow-diverting stents has gained acceptance during the past few years for the treatment of numerous intracranial aneurysms, especially large or giant ones. However, successful catheterization of the distal parent artery in giant intracranial aneurysms with a microcatheter can be extremely challenging. Forming a microcatheter loop in the aneurysm sac can aid distal catheterization. CLINICAL PRESENTATION: We report the use of a Solitaire FR stent as an adjunctive tool in the successful treatment of 2 giant intracranial unruptured aneurysms with a Pipeline Embolization Device. After having formed a loop inside the aneurysm sac, the microcatheter was anchored distally by a Solitaire FR stent. With the Solitaire FR device opened, the loop in the giant aneurysm sac was completely reduced without loss of the microcatheter position in the distal parent artery. A Pipeline Embolization Device could be delivered in both cases without any difficulty. There were no complications. CONCLUSION: The technique described results in ideal microcatheter alignment with a secure distal position before deployment of a flow-diverting stent.

scholarly journals Peri-Procedural Morbidity and Mortality Associated with Stent-Assisted Coiling for Intracranial Aneurysms

2013 ◽  
Vol 19 (1) ◽  
pp. 43-48 ◽  
Author(s):  
K. Wang ◽  
Y. Sun ◽  
A-M. Li
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Mortality Rates ◽  
Stent Migration ◽  
Aneurysm Rupture ◽  
Morbidity And Mortality ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Attractive Option ◽  
Technological Improvements

Despite experience and technological improvements, stent-assisted coiling for intracranial aneurysms still has inherent risks. We evaluated peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms. Patients with cerebral aneurysms that were broad-based (>4 mm) or had unfavorable dome/neck ratios (<1.5) were enrolled in this study between February and November 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with adjunctive coil embolization. Seventy-two consecutive patients (27 men and 45 women; 22–78 years of age; mean age, 52.8 years) underwent 13 procedures for 13 ruptured aneurysms and 64 procedures for 73 unruptured aneurysms. Nine [11.7%, 95% CI(4.5%–18.9%)] procedure-related complications occurred: one and eight with initial embolization of ruptured and unruptured aneurysms, respectively. Complications included six acute in-stent thromboses, one spontaneous stent migration, one post-procedural aneurysm rupture, and one perforator occlusion. Three complications had no neurologic consequences. Two caused transient neurologic morbidity, two persistent neurologic morbidity, and two death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 5.2% (95%CI, 0.2%–10.2%) and 2.6% (95%CI, 0%–6.2%); ruptured aneurysms, 7.7% (95%CI, 0%–36%) and 0% (95%CI, 0%–25%); unruptured aneurysms, 4.7% (95%CI, 0%–9.9%) and 3.1% (95%CI, 0%–7.3%). Combined procedure-related morbidity and mortality rates for ruptured and unruptured aneurysms were 7.7% (95%CI, 1.7%–13.7%) and 7.8% (95%CI, 1.8%–13.8%), respectively. Stent-assisted coiling is an attractive option for intracranial aneurysms. However, stent-assisted coiling for unruptured aneurysms is controversial for its comparable risk to natural history.

Self-Reported Headaches in Patients with Unruptured Intracranial Aneurysms Treated with the Pipeline Embolization Device

2018 ◽  
Vol 113 ◽  
pp. e364-e372 ◽  
Author(s):  
Anna M. Schneider ◽  
Justin M. Moore ◽  
Nimer Adeeb ◽  
Raghav Gupta ◽  
Christoph J. Griessenauer ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Pipeline Embolization Device ◽  
Unruptured Intracranial Aneurysms

scholarly journals Involvement of neutrophils in machineries underlying the rupture of intracranial aneurysms in rats

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mika Kushamae ◽  
Haruka Miyata ◽  
Manabu Shirai ◽  
Kampei Shimizu ◽  
Mieko Oka ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Collagenolytic Activity ◽  
Inflammatory Stimuli ◽  
Technical Advances ◽  
Gene Expression Profile Data ◽  
Metalloproteinase 9 ◽  
Immunohistochemical Analyses

AbstractSubarachnoid hemorrhage due to rupture of an intracranial aneurysm has a quite poor prognosis after the onset of symptoms, despite the modern technical advances. Thus, the mechanisms underlying the rupture of lesions should be clarified. To this end, we obtained gene expression profile data and identified the neutrophil-related enriched terms in rupture-prone lesions using Gene Ontology analysis. Next, to validate the role of neutrophils in the rupture of lesions, granulocyte-colony stimulating factor (G-CSF) was administered to a rat model, in which more than half of induced lesions spontaneously ruptured, leading to subarachnoid hemorrhage. As a result, G-CSF treatment not only increased the number of infiltrating neutrophils, but also significantly facilitated the rupture of lesions. To clarify the mechanisms of how neutrophils facilitate this rupture, we used HL-60 cell line and found an enhanced collagenolytic activity, corresponding to matrix metalloproteinase 9 (MMP9), upon inflammatory stimuli. The immunohistochemical analyses revealed the accumulation of neutrophils around the site of rupture and the production of MMP9 from these cells in situ. Consistently, the collagenolytic activity of MMP9 could be detected in the lysate of ruptured lesions. These results suggest the crucial role of neutrophils to the rupture of intracranial aneurysms; implying neutrophils as a therapeutic or diagnostic target candidate.

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