scholarly journals Predictors of Peri-Ophthalmic Aneurysm Incomplete Occlusion and Visual Symptoms After Treatment with a Pipeline Embolization Device: A Multi-Center Cohort Study

2021 ◽  
Author(s):  
CHAO XU ◽  
PEI WU ◽  
BOWEN SUN ◽  
SHANCAI XU ◽  
BIN LUO ◽  
...  
Keyword(s):  
Type B ◽  
Pipeline Embolization Device ◽  
Aneurysm Neck ◽  
Visual Symptoms ◽  
Post Market ◽  
Occlusion Rate ◽  
Ophthalmic Segment Aneurysms ◽  
Incomplete Occlusion ◽  
The Relationship

Abstract Objective: Peri-ophthalmic aneurysm is a special type of aneurysm. We assessed the relationship between ophthalmic artery (OA) origin and aneurysm and examined the effect of a pipeline embolization device (PED, Covidien/Medtronic) with or without coils on aneurysm occlusion rate and visual outcomes.Methods: We retrospectively analyzed 194 peri-ophthalmic aneurysms in 189 patients among 1,171 patients treated with a PED in a Chinese post-market multi-center registry study from November 2014 to October 2019. Peri-ophthalmic aneurysms were defined as carotid–ophthalmic segment aneurysms arising from the internal carotid artery dorsal wall at, or distal to, the OA origin, with a superior or superomedial projection. The relationship between OA origin and the aneurysm was classified as follows: Type A, OA originating separate from the aneurysm; Type B, OA originating from the aneurysm neck or dome. Patients with aneurysm were divided into the PED-only group and the PED + coils group according to treatment. Results: The median follow-up time was 6.8 months (range, 5.3–20.2 months). There were 163 occluded aneurysms (84%) and 31 aneurysms with incomplete occlusion (16%). A multivariate analysis showed that Type B aneurysm was a risk factor for incomplete occlusion in the PED-only group (odds ratio [OR] 4.951, 95% confidence interval [CI] 1.904-12.875, p = 0.001). Visual symptoms at final follow up correlated with preoperative visual symptoms (OR 16.005, 95% CI 2.505-102.273, p = 0.003).Conclusions: Type B aneurysm is associated with a lower occlusion rate after PED-only treatment. Patients with preoperative visual symptoms should be treated promptly to avoid permanent visual symptoms.

Reduced Efficacy of the Pipeline Embolization Device in the Treatment of Posterior Communicating Region Aneurysms with Fetal Posterior Cerebral Artery Configuration

Neurosurgery ◽  
2017 ◽  
Vol 82 (5) ◽  
pp. 695-700 ◽  
Author(s):  
Anil K Roy ◽  
Brian M Howard ◽  
Diogo C Haussen ◽  
Joshua W Osbun ◽  
Sameer H Halani ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Clinical Symptoms ◽  
Posterior Cerebral Artery ◽  
Neurological Complications ◽  
Class I ◽  
Class Iii ◽  
Pipeline Embolization Device ◽  
Independent Association ◽  
Incomplete Occlusion

Abstract BACKGROUND Aneurysms at the origin of the posterior communicating artery (PcommA) have been demonstrated to be effectively treated with the pipeline embolization device (PED). Much less is known about the efficacy of the PED for aneurysms associated with a fetal posterior cerebral artery (fPCA) variant. OBJECTIVE To study PED treatment efficacy of PcommA aneurysms, including fPCA aneurysms. METHODS A prospectively maintained university database of aneurysm patients treated with the PED was retrospectively reviewed. Demographics, treatment details, and imaging were reviewed for all PcommA and fPCA aneurysms. RESULTS Out of a total of 285 patients treated with PED, 50 patients (mean age 57.5 ± 12.2 yr, 42 females) with unruptured PcommA (9 fPCA) aneurysms were identified. Mean follow-up duration was 14.0 ± 11.6 mo (48 patients). Roy-Raymond class I occlusion on follow-up magnetic resonance or catheter angiography (mean time 11.7 ± 6.8 mo) was achieved in 30 patients (62.5%), class II occlusion in 11 patients (22.9%) and class III occlusion in 7 patients (14.5%). The PcommA was occluded in 56% of patients without any clinical symptoms. No deaths or permanent neurological complications occurred. In fPCA aneurysms, class I occlusion was seen in 1 patient, class 2 occlusion in 2 patients, and class III occlusion in 6 patients. Multivariate analysis revealed an independent association between incomplete occlusion and fPCA configuration (OR 73.65; 95% CI: 5.84-929.13; P = .001). CONCLUSION The PED is a safe and effective treatment for PcommA aneurysms, although fetal anatomy should increase consideration of traditional endovascular techniques or surgical clipping.

scholarly journals Endovascular Treatment of Paraclinoid Aneurysms

2011 ◽  
Vol 17 (4) ◽  
pp. 425-430 ◽  
Author(s):  
Y. Sun ◽  
Y. Li ◽  
A-M. Li
Keyword(s):  
Endovascular Treatment ◽  
Brain Infarction ◽  
Endovascular Techniques ◽  
Paraclinoid Aneurysms ◽  
Type Size ◽  
Efficient Alternative ◽  
Ophthalmic Segment Aneurysms ◽  
Incomplete Occlusion ◽  
And Control

The anatomical complexity of the paraclinoid region has made surgical treatment of intracranial ophthalmic segment aneurysms (OSAs) difficult. This study evaluated the safety and efficacy of endovascular treatment of paraclinoid aneurysms. We conducted a retrospective study of 28 patients with 30 aneurysms of the paraclinoid in whom treatment with endovascular techniques was attempted. Patient age, sex, presence of subarachnoid hemorrhage, aneurysm type, size of aneurismal sac and treatment modality were reviewed. Clinical evaluation and control angiography were performed between one and 43 months. Overall, complete occlusion was obtained in 26 aneurysms (86.6%), nearly complete (>90%) occlusion in two aneurysms (6.7%) and incomplete occlusion was observed in two aneurysms (6.7%). All endovascular techniques were successful. Procedure-related complications were observed in two patients (7.1%). Patients underwent follow-up for a mean of 14.8 months (range 1–43 months). Repeated coil treatment was performed in one patient. One patient died of massive brain infarction six days postoperatively and thus no follow-up data were available for this case. In 27 patients with follow-up studies, aneurysm closure was complete in 22 (81.5%) and incomplete in five (18.5%). Endovascular treatment is a safe and efficient alternative approach for paraclinoid aneurysms.

Intracranial aneurysms managed by parent artery reconstruction using Tubridge: Study protocol for a prospective, multicenter, post-market clinical trial

2020 ◽  
pp. 159101992097623
Author(s):  
Qiaowei Wu ◽  
Li Li ◽  
Qiuji Shao ◽  
Tianming Xu ◽  
Kaitao Chang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intracranial Aneurysms ◽  
Parent Artery ◽  
Reconstruction Technique ◽  
Long Term Outcomes ◽  
Complete Occlusion ◽  
Post Market ◽  
Occlusion Rate

Background As a new endovascular reconstruction technique, flow diverter (FD) shows excellent efficacy and safety for treatment of intracranial aneurysms. In a previous multicenter, randomized, controlled, pre-market study, Tubridge FD showed remarkably higher complete occlusion rate compared with traditional stent-assisted coiling. However, a nonsignificant higher complication rate in the Tubridge group was noted. Considering the learning curve, the safety, and long-term outcomes of Tubridge FD should be verified in new prospective, real world, multicenter, post-market trials. Methods This study is a prospective, multicenter, single-arm, post-market clinical trial that evaluates the safety and efficacy of Tubridge in the treatment of patients with intracranial aneurysms by reconstructing parent artery. We expect 200 participants who meet the inclusion and exclusion criteria to be included. Clinical information and angiographic results (Raymond–Roy grading scale, RRGS) will be recorded objectively. The primary endpoint will be the complete occlusion rate of the target aneurysm (RRGS 1) at 12-month follow-up. Secondary endpoints will include the adequate occlusion rate (RRGS 1 & 2) and the rate of major in-stent stenosis (>50%) at 12-month follow-up, technique success rate, changes of modified Rankin Scale before and after the procedure, the rate of aneurysm related disability, neurological mortality, and all-cause mortality within follow-up period. Discussion This post-market, prospective trial may offer more information on the safety and long-term outcomes of Tubridge FD. When the study is complete, the results may provide us a new strategy for the treatment of intracranial aneurysms. Trial registration: WHO-Chinese Clinical Trial Registry: ChiCTR2000032282.

Predictive factors of incomplete aneurysm occlusion after endovascular treatment with the Pipeline embolization device

2020 ◽  
Vol 132 (5) ◽  
pp. 1598-1605 ◽  
Author(s):  
Georgios A. Maragkos ◽  
Luis C. Ascanio ◽  
Mohamed M. Salem ◽  
Sricharan Gopakumar ◽  
Santiago Gomez-Paz ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Predictive Factors ◽  
Cohort Analysis ◽  
Multivariable Analysis ◽  
Pipeline Embolization Device ◽  
Unruptured Aneurysms ◽  
Maximal Diameter ◽  
Aneurysm Occlusion ◽  
Incomplete Occlusion

OBJECTIVEThe Pipeline embolization device (PED) is a routine choice for the endovascular treatment of select intracranial aneurysms. Its success is based on the high rates of aneurysm occlusion, followed by near-zero recanalization probability once occlusion has occurred. Therefore, identification of patient factors predictive of incomplete occlusion on the last angiographic follow-up is critical to its success.METHODSA multicenter retrospective cohort analysis was conducted on consecutive patients treated with a PED for unruptured aneurysms in 3 academic institutions in the US. Patients with angiographic follow-up were selected to identify the factors associated with incomplete occlusion.RESULTSAmong all 3 participating institutions a total of 523 PED placement procedures were identified. There were 284 procedures for 316 aneurysms, which had radiographic follow-up and were included in this analysis (median age 58 years; female-to-male ratio 4.2:1). Complete occlusion (100% occlusion) was noted in 76.6% of aneurysms, whereas incomplete occlusion (≤ 99% occlusion) at last follow-up was identified in 23.4%. After accounting for factor collinearity and confounding, multivariable analysis identified older age (> 70 years; OR 4.46, 95% CI 2.30–8.65, p < 0.001); higher maximal diameter (≥ 15 mm; OR 3.29, 95% CI 1.43–7.55, p = 0.005); and fusiform morphology (OR 2.89, 95% CI 1.06–7.85, p = 0.038) to be independently associated with higher rates of incomplete occlusion at last follow-up. Thromboembolic complications were noted in 1.4% and hemorrhagic complications were found in 0.7% of procedures.CONCLUSIONSIncomplete aneurysm occlusion following placement of a PED was independently associated with age > 70 years, aneurysm diameter ≥ 15 mm, and fusiform morphology. Such predictive factors can be used to guide individualized treatment selection and counseling in patients undergoing cerebrovascular neurosurgery.

scholarly journals The role of endovascular treatment in unruptured basilar tip aneurysms

2016 ◽  
Vol 23 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Huijian Ge ◽  
Xianli Lv ◽  
Hengwei Jin ◽  
Zhihua Tian ◽  
Youxiang Li ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Endovascular Treatment ◽  
Potential Risk ◽  
Complete Occlusion ◽  
Delayed Hemorrhage ◽  
Hemorrhagic Events ◽  
Occlusion Rate ◽  
The Mean ◽  
Incomplete Occlusion

Objective This study was to evaluate the safety and efficiency of endovascular treatment of unruptured basilar tip aneurysms. Methods We retrospectively reviewed consecutive 79 cases of unruptured basilar tip aneurysms in our center between 2009 and 2014. The patients’ clinical and imaging information were recorded. Complications, initial occlusion rate, clinical outcomes and the predictors were retrospectively analyzed. Results Thirty-five cases received conservative treatment and 44 cases were treated by endovascular embolization. In the conservative treatment group, six (19.4%) of 31 basilar tip aneurysms ruptured and resulted in five deaths (16.1%) during the mean 18.1-month follow-up (range from 1 to 60 months). Among the endovascularly treated cases, 24 (54.5%) achieved initial complete occlusion and no delayed hemorrhagic events occurred during the mean 33.6-month follow-up (range from 10 to 68 months). For 20 (45.5%) incompletely occluded cases, five postoperative or delayed hemorrhagic events and two mass effect events resulted in six deaths. There were no statistical significant differences in hemorrhagic events ( p = 0.732) and mortality ( p = 0.502) between the incomplete occlusion group and untreated group. Large aneurysm size (≥10 mm) was an independent predictor for incomplete occlusion ( p = 0.002), which had a potential risk of postoperative or delayed hemorrhage. On univariate analysis, initial occlusion rate and aneurysm size were found to be associated with clinical outcomes ( p = 0.042 and 0.015). Conclusion Complete occlusion for unruptured basilar tip aneurysm proved to be a safe and effective therapeutic method that could eliminate the potential risk of postoperative or delayed hemorrhage.

scholarly journals Hemodynamic Analysis for Endovascular Treatment in Small Unruptured Intracranial Aneurysms: A Matched Comparison Study of Flow Diverter Versus LVIS

2021 ◽  
Author(s):  
Jian Liu ◽  
Wenqiang Li ◽  
Yisen Zhang ◽  
Kun Wang ◽  
Xinjian Yang ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Clinical Analysis ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Unruptured Intracranial Aneurysms ◽  
Key Factor ◽  
Occlusion Rate ◽  
Two Parameters

Abstract BackgroundWe compared the treatment of small unruptured intracranial aneurysms (UIAs) with flow diverter and LVIS assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment.MethodsFifty-one UIAs in 51 patients treated with pipeline embolization device (PED) were included in this study, and defined as the PED group. We matched controls 1:1 and enrolled 51 UIAs who treated with LVIS stent, which defined as the LVIS group. Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS. Clinical analysis was also performed between these two groups after the match.ResultsThere was no difference in procedural complications between two groups (P=0.558). At the first angiographic follow-up, the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group (98.0% vs 82.4%, P = 0.027). However, during the further angiographic follow-up, the complete occlusion rate in PED group achieved 100%, which was higher than that in LVIS group (98.0%). Compared with the LVIS group after treatment, cases in PED group showed a higher value of velocity in the aneurysm (0.03 ± 0.09 vs 0.01 ± 0.01, P=0.037) and WSS on the aneurysm (2.32 ± 5.40 vs 0.33 ± 0.47, P=0.011). Consequently, the reduction ratios of these two parameters were also showed statistical differences. These parameters in LVIS group showed much higher reduction ratios. However, the reduction ratio of the velocity on the neck plane was comparable between two groups. ConclusionsBoth LVIS and PED were safe and effective for the treatment of small UIAs. However, LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED. The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.

scholarly journals Hemodynamic analysis for endovascular treatment in small unruptured intracranial aneurysms: a matched comparison study of flow diverter versus LVIS

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jian Liu ◽  
Wenqiang Li ◽  
Yisen Zhang ◽  
Kun Wang ◽  
Xinjian Yang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Clinical Analysis ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate ◽  
Two Parameters

Abstract Background We compared the treatment of small unruptured intracranial aneurysms (UIAs) with flow diverter and LVIS-assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment. Methods Fifty-one UIAs in 51 patients treated with pipeline embolization device (PED) were included in this study and defined as the PED group. We matched controls 1:1 and enrolled 51 UIAs who were treated with LVIS stent, which were defined as the LVIS group. Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS. Clinical analysis was also performed between these two groups after the match. Results There was no difference in procedural complications between the two groups (P = 0.558). At the first angiographic follow-up, the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group (98.0% vs. 82.4%, P = 0.027). However, during the further angiographic follow-up, the complete occlusion rate in the PED group achieved 100%, which was higher than that in the LVIS group (98.0%). Compared with the LVIS group after treatment, cases in the PED group showed a higher value of velocity in the aneurysm (0.03 ± 0.09 vs. 0.01 ± 0.01, P = 0.037) and WSS on the aneurysm (2.32 ± 5.40 vs. 0.33 ± 0.47, P = 0.011). Consequently, the reduction ratios of these two parameters also showed statistical differences. These parameters in the LVIS group showed much higher reduction ratios. However, the reduction ratio of the velocity on the neck plane was comparable between two groups. Conclusions Both LVIS and PED were safe and effective for the treatment of small UIAs. However, LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED. The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.

Use of Coils in Conjunction With the Pipeline Embolization Device for Treatment of Intracranial Aneurysms

Neurosurgery ◽  
2014 ◽  
Vol 76 (2) ◽  
pp. 142-149 ◽  
Author(s):  
Ning Lin ◽  
Adam M. Brouillard ◽  
Chandan Krishna ◽  
Maxim Mokin ◽  
Sabareesh K. Natarajan ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Neurological Complications ◽  
Controlled Study ◽  
Group Differences ◽  
Pipeline Embolization Device ◽  
Complex Anatomy ◽  
Risk Of Rupture ◽  
Aneurysm Occlusion ◽  
Occlusion Rate

ABSTRACT BACKGROUND: Coiling in conjunction with Pipeline embolization device (PED) placement could provide immediate dome protection and an intraaneurysmal scaffold to prevent device prolapse for intracranial aneurysms with high rupture risk and complex anatomy. OBJECTIVE: To report results after treatment of aneurysms with PED with coils (PED+coils group) or without (PED-only group) at a single-institution. METHODS: In this case-controlled study, records of patients who underwent PED treatment between 2011 and 2013 were retrospectively reviewed. RESULTS: Twenty-nine patients were treated with PED+coils and 75 with PED-only. No statistically significant between-group differences were found in terms of age, sex, aneurysm location, medical comorbidities, and length of follow-up. Aneurysms treated by PED+coils were larger (16.3 mm vs 12.4 mm, P = .02) and more likely to be ruptured (20.7% vs 1.3%, P = .001) or dissecting (34.5% vs 9.3%, P = .002). PED deployment was successful in all cases. At the latest follow-up (mean, 7.8 months), complete aneurysm occlusion was achieved in a higher proportion of the PED+coils group (93.1% vs 74.7%, P = .03). Device foreshortening/migration occurred in 4 patients in the PED-only group and none in the PED+coils group. Fewer patients required retreatment in the PED+coils group (3.4% vs 16.0%, P = .71). Rates of neurological complications (10.3% PED+coils vs 8.0% PED-only, P = .7) and favorable outcome (modified Rankin Scale score = 0-2; 93.1% PED+coils vs 94.7% PED-only, P = .6) were similar. CONCLUSION: PED+coils may be a safe and effective treatment for aneurysms with high risk of rupture (or rerupture) and complex anatomy. Coiling in conjunction with PED placement provided a higher aneurysm occlusion rate and reduced the need for retreatment.

Flow-Diversion for Ophthalmic Segment Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 76 (3) ◽  
pp. 286-290 ◽  
Author(s):  
Mario Zanaty ◽  
Nohra Chalouhi ◽  
Guilherme Barros ◽  
Eric Winthrop Schwartz ◽  
Mark Philip Saigh ◽  
...  
Keyword(s):  
Complication Rate ◽  
Flow Diversion ◽  
High Rate ◽  
Complication Rates ◽  
Complete Occlusion ◽  
Obliteration Rate ◽  
Visual Symptoms ◽  
Aneurysm Occlusion ◽  
Ophthalmic Segment Aneurysms ◽  
Incomplete Occlusion

Abstract BACKGROUND: The use of flow-diversion to treat ophthalmic segment aneurysms (OSA) has not been well evaluated. OBJECTIVE: To assess the visual outcomes, the obliteration rate, and the need for retreatment of OSA treated by the pipeline embolization device (PED). METHODS: Patients who underwent treatment with PED for OSA from 2009 to 2014 were selected and retrospectively reviewed. Patient's age, sex, mode of presentation, and aneurysm size were recorded. The complication rates, the need for retreatment (due to recurrence of the aneurysm or worsening symptoms), the aneurysm occlusion rates, the evolution of visual symptoms, and the evolution of headache/retro-orbital pain were registered. RESULTS: Forty-one patients harboring 44 OSA treated by flow-diversion were identified. Females constituted 87.80% (37/41) of the cohort. The mean age was 59.16 ± 12.54 years. At final angiographic follow-up, 77.27% (34/44) had complete occlusion, 6.81% (3/44) had near-complete occlusion, and 15.90% (7/44) had incomplete occlusion. Of the 22 symptomatic OSA, complete resolution or significant improvement was noted in 72.72% (16/22), while worsening of symptoms occurred in 4.54% (1/22). Five patients out of 22 (22.72%; 5/22) had no significant changes in their symptoms. The complication rate was 2.27% (1/44). The mortality rate was 0%. CONCLUSION: The low complication rate, the high obliteration rate, and the high rate of improvement in the visual symptoms make flow-diversion an appealing option for the treatment of OSA.

Flow Diverters for Treatment of 160 Ophthalmic Segment Aneurysms: Evaluation of Safety and Efficacy in a Multicenter Cohort

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 726-732 ◽  
Author(s):  
Christoph J. Griessenauer ◽  
Ronie L. Piske ◽  
Carlos E. Baccin ◽  
Benedito J.A. Pereira ◽  
Arra S. Reddy ◽  
...  
Keyword(s):  
Flow Diverter ◽  
Safety And Efficacy ◽  
Complete Occlusion ◽  
Multicenter Cohort ◽  
Retreatment Rate ◽  
Permanent Morbidity ◽  
Ophthalmic Segment Aneurysms ◽  
Incomplete Occlusion ◽  
Flow Diverters

Abstract BACKGROUND: Treatment of ophthalmic segment aneurysms (OSA) remains challenging. Flow diverter stents (FDS) have evolved as a promising endovascular treatment option for aneurysms of the internal carotid artery and are associated with high occlusion rates and a favorable morbidity and mortality profile. OBJECTIVE: To determine safety and efficacy of FDS for OSA in a large, multicenter cohort. METHODS: A retrospective analysis of prospectively maintained databases of 127 consecutive patients harboring 160 OSA treated with FDS was performed. Aneurysms were classified based on location and morphology. Follow-up with digital subtraction angiography (DSA) was performed 6 to 18 months after treatment. RESULTS: Follow-up DSA was available for 101 (63.1%) aneurysms with a mean follow-up of 18 months. Complete occlusion was observed in 90 aneurysms (89.1%), near-complete occlusion (&gt;95%) in 3 (3%), and incomplete occlusion (&lt;95%) in 8 aneurysms (7.9%). One aneurysm was retreated with another FDS (0.9%). No risk factors for incomplete occlusion were identified. The OA was occluded at the latest follow-up in 6 cases (7.1%). Permanent morbidity occurred in 4 patients (3.1%), and there was no mortality related to the FDS procedure. CONCLUSION: Treatment of OSA with FDS was found to be safe and effective. The retreatment rate was extremely low and aneurysms that occluded did not reanalyze.

Sign in / Sign up

Export Citation Format

Share Document