Occlusion rates of intracranial aneurysms treated with the Pipeline embolization device: the role of branches arising from the sac

OBJECTIVEThe aim of this study was to compare the clinical and angiographic outcomes of intracranial aneurysms with and without branches arising from the sac after Pipeline embolization device (PED) treatment.METHODSThis retrospective 2-center comparative study included 116 patients with 157 aneurysms that were treated with PEDs. Aneurysms were divided into 2 groups: one group had branches arising from the sac and the other group did not. Study end points included total aneurysm occlusion assessed by angiography at 6 and 12 months, death or stroke, technical complications, in-stent stenosis, patency of covered branches, and transient ischemia.RESULTSOne hundred fifty-one aneurysms (96%) were located in the internal carotid artery. A branch arising from the sac was observed in 26 aneurysms. Complete occlusion was found in 120 of 156 aneurysms at 6 months (76.92% [95% CI 69.71%–82.84%]) and in 136 of 155 aneurysms at 12 months (87.74% [95% CI 81.28%–92.27%]). Total occlusion was more frequently observed in the group without a branch arising from the sac (84% vs 40% at 6 months, p < 0.001; 93.10% vs 60% at 1 year, p < 0.001). There were 4 (3.45% [95% CI 1.11%–9.12%]) cases of death or major stroke. Amaurosis fugax occurred in 3 patients. One patient experienced worsening of mass effect after treatment. No occlusion of branches arising from the aneurysm was observed. In-stent stenosis greater than 50% was observed in 1 case.CONCLUSIONSAneurysms treated with PEDs are less likely to be totally occluded if they have a branch arising from the sac than are aneurysms without these branches.

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Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

Interventional Neuroradiology ◽

10.1177/1591019918809932 ◽

2018 ◽

Vol 25 (2) ◽

pp. 182-186

Author(s):

Manoj Bohara ◽

Kosuke Teranishi ◽

Kenji Yatomi ◽

Takashi Fujii ◽

Takayuki Kitamura ◽

...

Keyword(s):

Internal Carotid ◽

Flow Diversion ◽

Total Occlusion ◽

Pipeline Embolization Device ◽

Complete Occlusion ◽

Radiological Features ◽

Long Term Follow Up ◽

Aneurysm Occlusion

Background Flow diversion with the Pipeline embolization device (PED) is a widely accepted treatment modality for aneurysm occlusion. Previous reports have shown no recanalization of aneurysms on long-term follow-up once total occlusion has been achieved. Case description We report on a 63-year-old male who had a large internal carotid artery cavernous segment aneurysm. Treatment with PED resulted in complete occlusion of the aneurysm. However, follow-up angiography at four years revealed recurrence of the aneurysm due to disconnection of the two PEDs placed in telescoping fashion. Conclusion Herein, we present the clinico-radiological features and discuss the possible mechanisms resulting in the recanalization of aneurysms treated with flow diversion.

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Pipeline Embolization device for intracranial aneurysms in a large Chinese cohort: factors related to aneurysm occlusion

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286420967828 ◽

2020 ◽

Vol 13 ◽

pp. 175628642096782

Author(s):

Bin Luo ◽

Huibin Kang ◽

Hongqi Zhang ◽

Tianxiao Li ◽

Jianmin Liu ◽

...

Keyword(s):

Blood Flow ◽

Intracranial Aneurysms ◽

Registry Study ◽

Vessel Occlusion ◽

Clinical Trial Registration ◽

Pipeline Embolization Device ◽

Venous Phase ◽

Aneurysm Occlusion ◽

Occlusion Rate ◽

Stent Stenosis

Background and Purpose: The Pipeline Embolization Device (PED, Covidien/Medtronic) is widely used to treat intracranial aneurysms. This PED in China post-market multi-center registry study (PLUS) investigated safety and effectiveness of the PED for intracranial aneurysms in the Chinese population. Methods: This was a panoramic, consecutive, real-world cohort registry study. Patients treated with PED with or without coils between November 2014 and October 2019 at 14 centers in China were included, and those treated by parent vessel occlusion or other stents were excluded. Study outcomes included angiographic evaluation of aneurysm occlusion, complications, in-stent stenosis, and predictors of aneurysm occlusion. A central committee reviewed all imaging and endpoint events. Results: In total, 1171 patients with 1322 intracranial aneurysms were included. The total occlusion rate was 81.4% (787/967) at mean follow-up of 8.96 ± 7.50 months, with 77.1% (380/493) occlusion in the PED alone and 85.9% (407/474) in the PED plus coiling group. On multi-variate analysis, female sex, hyperlipidemia, vertebral aneurysms, PED plus coiling, and blood flow detained to venous phase were significant predictors of aneurysm occlusion. In posterior circulation cohort, there was no variable associated with aneurysm occlusion. In-stent stenosis predictors included current smoking and cerebral sclerosis/stenosis. Conclusion: In the largest series on PED of multi-center date of China, data suggest that treatment with the flow-diverting PED in intracranial aneurysms was efficacious. The treatment of PED combined coiling and blood flow detained to venous phase after PED implant were associated with aneurysmal occlusion. The occlusion rate of vertebral aneurysms was higher than other location aneurysms. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT03831672.

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Pipeline embolization device retraction and foreshortening after internal carotid artery blister aneurysm treatment

Interventional Neuroradiology ◽

10.1177/1591019917722514 ◽

2017 ◽

Vol 23 (6) ◽

pp. 614-619 ◽

Cited By ~ 4

Author(s):

Jeremy J Heit ◽

Nicholas A Telischak ◽

Huy M Do ◽

Robert L Dodd ◽

Gary K Steinberg ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

High Morbidity ◽

Case Description ◽

Digital Subtraction ◽

Pipeline Embolization Device ◽

Aneurysm Occlusion ◽

New Treatment

Background Subarachnoid hemorrhage (SAH) secondary to rupture of a blister aneurysm (BA) results in high morbidity and mortality. Endovascular treatment with the pipeline embolization device (PED) has been described as a new treatment strategy for these lesions. We present the first reported case of PED retraction and foreshortening after treatment of a ruptured internal carotid artery (ICA) BA. Case description A middle-aged patient presented with SAH secondary to ICA BA rupture. The patient was treated with telescoping PED placement across the BA. After 5 days from treatment, the patient developed a new SAH due to re-rupture of the BA. Digital subtraction angiography revealed an increase in caliber of the supraclinoid ICA with associated retraction and foreshortening of the PED that resulted in aneurysm uncovering and growth. Conclusions PED should be oversized during ruptured BA treatment to prevent device retraction and aneurysm regrowth. Frequent imaging follow up after BA treatment with PED is warranted to ensure aneurysm occlusion.

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Flow diverter for endovascular treatment of intracranial mirror segment internal carotid artery aneurysms

Interventional Neuroradiology ◽

10.1177/1591019918792536 ◽

2018 ◽

Vol 25 (1) ◽

pp. 4-11 ◽

Cited By ~ 2

Author(s):

Anna Luisa Kühn ◽

Peter Kan ◽

Visish Srinivasan ◽

David E Rex ◽

Katyucia de Macedo Rodrigues ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Temporal Artery ◽

Flow Diverter ◽

Post Treatment ◽

Pipeline Embolization Device ◽

Device Placement ◽

Aneurysm Occlusion

Background To evaluate the feasibility and efficacy of the pipeline embolization device in the treatment of unruptured intracranial mirror segment aneurysms. Methods Out of a total of 338 subjects, 14 were identified harboring a total of 32 internal carotid artery mirror segment aneurysms that were treated with the pipeline embolization device and were consecutively enrolled into our study. We collected data on patient demographics, modified Rankin scale (mRS) at admission, aneurysm characteristics, clinical outcome at discharge, 3–9 and at 12–18 months as well as angiography results at follow-up. Results Patients’ mean age was 52.9 years; baseline mRS was 0 in all subjects. Pipeline embolization device placement was successful in all cases. Post-treatment mRS remained 0 in 13/14 patients. One patient experienced a small intraparenchymal hemorrhage and subarachnoid hemorrhage, associated with a frontoparietal infarction resulting in right upper extremity weakness and aphasia (post-treatment mRS 3). His mRS evaluation remained stable at the 3–9-month follow-up. Three to 9-month follow-up angiography (13/14 subjects) showed complete aneurysm occlusion in 24/30 aneurysms (80%), near complete and partial occlusion in three of 30 (10%) aneurysms each. At the 9-month follow-up, one patient experienced a complete occlusion of the anterior temporal artery branch but did not present with any clinical deficits. No mRS changes were encountered over a median 6-month follow-up period. Mid-term follow-up angiography (12–18 months) available in eight of 14 subjects showed complete aneurysm occlusion in all patients. Mild intimal hyperplasia was observed in one patient. Conclusions Flow diversion technology can be used for the treatment of unruptured mirror segment aneurysms in selected patients.

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

Neurosurgery ◽

10.1093/neuros/nyz380 ◽

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.

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Regrowth of a Large Intracranial Aneurysm after On-Label Use of the Pipeline Embolization Device

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_273_18 ◽

2019 ◽

Vol 10 (01) ◽

pp. 142-144 ◽

Cited By ~ 2

Author(s):

Ching-Jen Chen ◽

M. Rao Patibandla ◽

Min S. Park ◽

M. Yashar Kalani

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Intracranial Aneurysm ◽

Internal Carotid ◽

Pipeline Embolization Device ◽

Complete Occlusion ◽

Residual Component ◽

First Case ◽

Aneurysm Occlusion

ABSTRACTDespite the widespread use of the pipeline embolization device (PED), no complete aneurysm regrowth after its placement has been reported in the literature. We report the first case of aneurysm regrowth after the initial follow-up angiography demonstrating near-complete occlusion of the aneurysm and remodeling of the vessel with on-label PED use for a large 20 mm × 24 mm × 22 mm (width × depth × height) cavernous segment internal carotid artery (ICA) aneurysm. The patient was treated with two overlapping PED (4.5 mm × 20 mm and 5 mm × 20 mm). Follow-up angiogram at 4 months after treatment demonstrated remodeling of the ICA with a small residual component measuring approximately 7 mm × 8 mm × 7 mm. However, at 10 months after treatment, there was a complete regrowth of the aneurysm with interval growth, now measuring 25 mm × 28 mm × 18 mm. Despite the high aneurysm occlusion rates reported with the PED, persistent aneurysm filling and aneurysm regrowth, although rare, should not be overlooked.

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Republished: Recurrence of a totally occluded aneurysm after treatment with a pipeline embolization device

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013842.rep ◽

2018 ◽

Vol 11 (9) ◽

pp. e5-e5 ◽

Cited By ~ 2

Author(s):

Felipe Padovani Trivelato ◽

Alexandre Cordeiro Ulhôa ◽

Marco Tulio Rezende ◽

Luis Henrique Castro-Afonso ◽

Daniel Giansante Abud

Keyword(s):

Intracranial Aneurysms ◽

Artery Aneurysm ◽

Middle Cerebral Artery Aneurysm ◽

Pipeline Embolization Device ◽

Additional Control ◽

Aneurysm Occlusion ◽

Cerebral Artery Aneurysm ◽

Wide Neck ◽

Control Angiography

Treatment with a pipeline embolization device (PED) is widely accepted as an excellent option for patients harboring giant, wide neck, saccular intracranial aneurysms. It has been shown to be safe and very effective. We describe a previously unreported case of a large middle cerebral artery aneurysm, related to the carotid tip, that was treated with a PED and coils. The 6 month follow-up angiogram demonstrated complete occlusion of the aneurysm. However, the 9 month angiogram revealed recurrent filling of the aneurysm sac. To our knowledge, this is the first report to describe recanalization of an aneurysm totally occluded on the control angiography after treatment with a PED. Unanswered questions include the mechanism of recanalization and the need for additional control angiograms and MRI following a previous examination revealing total aneurysm occlusion.

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The value of long-term angiographic follow-up following Pipeline embolization of intracranial aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017745 ◽

2021 ◽

pp. neurintsurg-2021-017745

Author(s):

David C Lauzier ◽

Samuel J Cler ◽

Arindam R Chatterjee ◽

Joshua W Osbun ◽

Christopher J Moran ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Post Treatment ◽

Multiple Time ◽

Angiographic Data ◽

Aneurysm Occlusion ◽

Multiple Time Points ◽

Actionable Findings ◽

Stent Stenosis

BackgroundFlow diversion of intracranial aneurysms with the Pipeline Embolization Device (PED) is commonly performed, but the value of long-term angiographic follow-up has not been rigorously evaluated. Here we examine the prevalence of actionable findings of aneurysm recurrence and development of in-stent stenosis in a cohort of patients that underwent long-term angiographic follow-up at multiple time points.MethodsAngiographic data from eligible patients were retrospectively assessed for aneurysm occlusion, in-stent stenosis, and aneurysm regrowth or recurrence. Patients were included in this study if they underwent angiographic imaging at 6 months post-treatment and at least one later time point.Results100% (132/132) of aneurysms occluded at 6 months remained occluded at final follow-up. 85.7% (6/7), 56.3% (27/48), and 25% (6/24) of aneurysms with entry remnant, subtotal filling, and total filling, respectively, at 6 months were completely occluded at final follow-up. 98.7% (147/149) of PED constructs that demonstrated no stenosis at 6 months demonstrated no stenosis at final angiography, while 44.4% (8/18) of PED constructs demonstrating in-stent stenosis at 6 months had resolution of stenosis on final angiography.ConclusionsAmong patients who undergo treatment of intracranial aneurysms with PED, the value of long-term angiography in patients demonstrating complete aneurysm occlusion and no in-stent stenosis on 6 month post-treatment angiography is low.

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Leo Stent for Endovascular Treatment of Broad-Necked and Fusiform Intracranial Aneurysms

Interventional Neuroradiology ◽

10.1177/159101990701300305 ◽

2007 ◽

Vol 13 (3) ◽

pp. 255-269 ◽

Cited By ~ 23

Author(s):

R. Juszkat ◽

S. Nowak ◽

S. Smóal ◽

W. Kociemba ◽

T. Blok ◽

...

Keyword(s):

Endovascular Treatment ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Internal Carotid ◽

Aneurysm Rupture ◽

Parent Vessel ◽

Stent Deployment ◽

Acute Setting ◽

Aneurysm Occlusion ◽

Braided Stent

The advent of intracranial stents has widened the indications for endovascular treatment of broad-necked and fusiform aneurysms. Leo stent is a self-expandable, nitinol, braided stent dedicated to intracranial vessels. The aim of this study is to present our experience in endovascular treatment of broad-necked and fusiform intracranial aneurysms using self-expanding, nitinol Leo stents. Between February 2004 and November 2006, 25 broad-necked and three fusiform aneurysms in 28 patients were treated using Leo stents in our centre. There were 18 patients who experienced acute subarachnoid haemorrhage due to aneurysm rupture, two patients who experienced SAH at least 12 months ago and in eight patients aneurysms were found incidentally. Aneurysms were located as follows: internal carotid artery, basilar artery, basilar tip, posterior inferior cerebral artery, M1/M2 segment, A2 segment and vertebral artery. There were no difficulties with stent deployment and delivery. All patients after acute SAH (n=18) underwent stent implantation and coil embolization in one procedure. The remaining patients underwent coil embolization in a staged procedure. Immediate aneurysm occlusion of more than 95% was achieved in all patients who underwent stent placement and coil embolization in one procedure. There were three thromboembolic complications encountered in patients in an acute setting of SAH, preloaded only on acetylsalicylic acid. Use of abciximab led to patency within the stent and parent vessel. However, one of these patients presented rebleeding from the aneurysm during administration of abciximab and died. Application of Leo stents in cases of broad-necked and fusiform intracranial aneurysms is safe and effective with a low complication rate.

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