scholarly journals Pipeline Embolization Device for the Treatment of Ruptured Intracerebral Aneurysms: A Multicenter Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Weiying Zhong ◽  
Hong Kuang ◽  
Ping Zhang ◽  
Xinjian Yang ◽  
Bin Luo ◽  
...  

Background and Purpose: The utilization of flow diversion for ruptured intracerebral aneurysms (IAs) is still limited. We aimed to demonstrate our multicenter experience using the pipeline embolization device (PED) for ruptured IAs that were difficult to treat by clipping and coiling.Methods: Thirty-eight patients with ruptured IAs who underwent PED treatment from 2015 to 2020 were retrospectively reviewed. Factors associated with procedure-related stroke (ischemic and hemorrhagic) and clinical and angiography outcomes were analyzed.Results: There were 14 (36.8%) saccular IAs, 12 (31.6%) blister-like IAs, and 12 (31.6%) dissecting IAs. Perforator involvement was noted in 10 (26.3%) IAs. Early PED placement ( ≤ 15 days) and adjunctive coiling treatment were performed in 27 (71.1%) and 22 (57.9%) cases, respectively. The overall rate of stroke-related complications was 31.6% (12/38) (including rates of 10.5% for procedure-related hemorrhagic complications and 15.8% for procedure-related infarction). The mortality rate was 13.2% (5/38), and 84.2% of patients (32/38) had favorable outcomes. Thirty-two (84.2%) patients underwent follow-up angiographic evaluations; of these, 84.4% (27 patients) had complete occlusion and 15.6% had incomplete obliteration. Multivariate analysis revealed that early PED placement was not associated with a high risk of procedure-related stroke or an unfavorable outcome. Adjunctive coiling exhibited an association with procedure-related stroke (p = 0.073). Procedure-related hemorrhagic complications were significantly associated with an unfavorable outcome (p = 0.003). Immediate contrast stasis in the venous phase was associated with complete occlusion during follow-up (p = 0.050).Conclusion: The PED is a feasible and effective treatment to prevent rebleeding and achieve aneurysm occlusion, but it is associated with a substantial risk of periprocedural hemorrhage and ischemic complications in acute ruptured IAs. Therefore, the PED should be used selectively for acutely ruptured IAs. Additionally, adjunctive coiling might increase procedure-related stroke; however, it may reduce aneurysm rebleeding in acutely ruptured IAs. Patients with immediate contrast stasis in the venous phase were more likely to achieve total occlusion. A prospective study with a larger sample size should be performed to verify our results.

2018 ◽  
Vol 25 (2) ◽  
pp. 182-186
Author(s):  
Manoj Bohara ◽  
Kosuke Teranishi ◽  
Kenji Yatomi ◽  
Takashi Fujii ◽  
Takayuki Kitamura ◽  
...  

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.


2016 ◽  
Vol 10 (1) ◽  
pp. 14
Author(s):  
Sara C Martinez ◽  
◽  
Sharonne N Hayes ◽  

The physiologic demands of pregnancy may either trigger or uncover ischemic heart disease (IHD) via largely unknown mechanisms, leading to an increased mortality compared with nonpregnant individuals. Risk factors for IHD in pregnancy are age, smoking, multiparity, and prior cardiac events. A multidisciplinary team at a referral center is key to coordinating medical or invasive management and inpatient observation. Etiologies may be revealed by experienced angiographers, and are predominantly spontaneous coronary artery dissection, followed by atherosclerotic disease and thrombus, while a significant percentage of women are found to have normal coronary arteries by angiogram. The management of these conditions is varied and, in general, conservative management is preferred with adequate coronary flow and stable hemodynamics. A woman with a history of IHD in pregnancy is at a substantial risk for further complications in future pregnancies and beyond; therefore, aggressive risk factor-reduction strategies and regular cardiology follow-up are imperative to decrease adverse events.


2019 ◽  
Vol 10 (01) ◽  
pp. 142-144 ◽  
Author(s):  
Ching-Jen Chen ◽  
M. Rao Patibandla ◽  
Min S. Park ◽  
M. Yashar Kalani

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.


2017 ◽  
Vol 42 (6) ◽  
pp. E8 ◽  
Author(s):  
David Dornbos ◽  
Constantine L. Karras ◽  
Nicole Wenger ◽  
Blake Priddy ◽  
Patrick Youssef ◽  
...  

OBJECTIVEThe utilization of the Pipeline embolization device (PED) has increased significantly since its inception and original approval for use in large, broad-necked aneurysms of the internal carotid artery. While microsurgical clipping and advances in endovascular techniques have improved overall efficacy in achieving complete occlusion, recurrences still occur, and the best modality for retreatment remains controversial. Despite its efficacy in this setting, the role of PED utilization in the setting of recurrent aneurysms has not yet been well defined. This study was designed to assess the safety and efficacy of PED in the recurrence of previously treated aneurysms.METHODSThe authors reviewed a total of 13 cases in which patients underwent secondary placement of a PED for aneurysm recurrence following prior treatment with another modality. The PEDs were used to treat aneurysm recurrence or residual following endovascular coiling in 7 cases, flow diversion in 2, and microsurgical clipping in 4. The mean time between initial treatment and retreatment with a PED was 28.1 months, 12 months, and 88.7 months, respectively. Clinical outcomes, including complications and modified Rankin Scale (mRS) scores, and angiographic evidence of complete occlusion were tabulated for each treatment group.RESULTSAll PEDs were successfully placed without periprocedural complications. The rate of complete occlusion was 80% at 6 months after PED placement and 100% at 12 months in these patients who underwent PED placement following failed endovascular coiling; there were no adverse clinical sequelae at a mean follow-up of 26.1 months. In the 2 cases in which PEDs were placed for treatment of residual aneurysms following prior flow diversion, 1 patient demonstrated asymptomatic vessel occlusion at 6 months, and the other exhibited complete aneurysm occlusion at 12 months. In patients with aneurysm recurrence following prior microsurgical clipping, the rate of complete occlusion was 100% at 6 and 12 months, with no adverse sequelae noted at a mean clinical follow-up of 27.7 months.CONCLUSIONSThe treatment of recurrent aneurysms with the PED following previous endovascular coiling, flow diversion, or microsurgical clipping is associated with a high rate of complete occlusion and minimal morbidity.


Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 925-933 ◽  
Author(s):  
Benjamin Gory ◽  
Marta Aguilar-Pérez ◽  
Elisa Pomero ◽  
Francis Turjman ◽  
Werner Weber ◽  
...  

Abstract BACKGROUND: Bifurcation middle cerebral artery (MCA) aneurysms with wide neck are amenable to endovascular coiling with pCONus stent, a recent device dedicated to wide-neck bifurcation intracranial aneurysms. OBJECTIVE: To evaluate the 1-year angiographic follow-up of wide-neck MCA aneurysms treated with pCONus. METHODS: Forty MCA aneurysms (mean dome size, 7.7 mm; mean neck size, 5.6 mm) coiled with pCONus were retrospectively evaluated. “Recanalization” was defined as worsening, and “progressive thrombosis” was defined as improvement on the Raymond scale. RESULTS: Angiographic midterm (mean, 11.9 months; range, 3-20) follow-up was obtained in all aneurysms. Retreatment was performed in 9 aneurysms (22.5%) without clinical complications, and postoperative angiographic outcome included 2 complete occlusions and 7 neck remnants. Six aneurysms were followed after retreatment (mean, 8.8 months), and presented complete occlusion in 1 case, neck remnant in 4 cases, and aneurysm remnant in 1 case. Among the 31 aneurysms, follow-up showed complete occlusion in 67.7% (21/31), neck remnants in 29% (9/31), and aneurysm remnants in 3.3% (1/31). Adequate aneurysm occlusion (total occlusion and neck remnant) was obtained in 96.7% (30/31). Among these 31 aneurysms, improvement of the rate of occlusion was observed in 15 aneurysms (48.4%), and recurrence in 2 aneurysms (6.5%). There was no 1-year angiographic recurrence of 3- or 6-month totally occluded aneurysms. CONCLUSION: pCONus stent allows a safe coiling of wide-neck MCA aneurysms usually considered as surgical with a low recanalization rate for those adequately occluded at 3 to 6 months. Angiographic results improve over time due to progressive aneurysm thrombosis in around 50% of cases.


2019 ◽  
Vol 130 (6) ◽  
pp. 1997-2004 ◽  
Author(s):  
Ryuta Nakae ◽  
Masaya Nagaishi ◽  
Yosuke Kawamura ◽  
Yoshihiro Tanaka ◽  
Akio Hyodo ◽  
...  

OBJECTIVEThe authors sought to demonstrate that hemorrhagic transformation of ischemic lesions is the main cause of delayed intracerebral hemorrhage (ICH) after Pipeline embolization device (PED) treatment and to estimate the rate of hemorrhagic transformation of new postprocedure ischemic lesions.METHODSPatients who underwent PED placement (PED group) from November 2015 to March 2017 or stent-mediated embolization (EN group) from December 2010 to October 2015 were retrospectively analyzed. Pre- and postprocedural MR images and 6-month follow-up MR images for each patient were scored for the presence of postprocedural bland ischemic and hemorrhagic lesions using diffusion-weighted MRI (DWI) and T2*-weighted MRI (T2*WI), respectively.RESULTSThe PED group comprised 28 patients with 30 intracranial aneurysms, and the EN group comprised 24 patients with 27 intracranial aneurysms. The mean number of ischemic lesions on DWI 1 day postprocedure was higher in the PED group than in the EN group (5.2 vs 2.7, p = 0.0010). The mean number of microbleeds detected on T2*WI 6 months postprocedure was higher in the PED group than in the EN group (0.6 vs 0.15, p = 0.028). A total of 36.7% of PED-treated patients exhibited new microbleeds on T2*WI at 6 months postprocedure, with at least 77.8% of these lesions representing hemorrhagic transformations of the new ischemic lesions observed on day 1 postprocedure. The rate of adjunctive coil embolization (27.3% vs 0.0%, p = 0.016) and the mean number of ischemic lesions observed 1 day postprocedure (6.6 vs 4.3, p = 0.020) were predictors of subsequent microbleeds in the PED group.CONCLUSIONSNew microbleeds detected using T2*WI at 6 months postprocedure were more common after PED treatment than after stent-mediated embolization. Approximately three-quarters of these lesions were hemorrhagic transformations of new ischemic lesions observed on day 1 postprocedure. Prevention of intraprocedural or postprocedural infarcts is necessary to reduce the risk of hemorrhagic complications following PED placement.


2021 ◽  
Vol 12 ◽  
Author(s):  
Weiqi Fu ◽  
Huijian Ge ◽  
Gang Luo ◽  
Xiangyu Meng ◽  
Jiejun Wang ◽  
...  

Background: Treatment of unruptured vertebral artery aneurysm involving posterior inferior cerebellar artery (PICA) is challenging. The experience of pipeline embolization device (PED) therapy for these lesions is still limited.Objective: To evaluate the safety and efficacy of the PED for unruptured vertebral artery aneurysm involving PICA.Methods: Thirty-two patients with unruptured vertebral artery aneurysm involving PICA underwent treatment with PED were retrospectively identified. Procedure-related complications, PICA patency, clinical, and angiographic outcomes were analyzed.Results: Thirty-two aneurysms were successfully treated without any procedure-related complications. Images were available in 30 patients (93.8%) during a period of 3–26 months follow-up (average 8.4 months), which confirmed complete occlusion in 17 patients (56.5%), near-complete occlusion in 9 patients (30%), and incomplete occlusion in one patient (3.3%). Parent artery occlusion (PAO) was occurred in 3 patients (10%). Twenty-eight of 30 PICA remained patent. The two occlusions of PICA were secondary to PAO. At a mean of 20.7 months (range 7–50 months) clinical follow-up, all the patients achieved a favorable outcome without any new neurological deficit.Conclusion: PED seems to be a safe and effective alternative endovascular option for patients with unruptured vertebral artery aneurysm involving PICA.


2021 ◽  
pp. neurintsurg-2021-018224
Author(s):  
Mohamed M Salem ◽  
Mirhojjat Khorasanizadeh ◽  
Sovann V Lay ◽  
Leonardo Renieri ◽  
Anna L Kuhn ◽  
...  

BackgroundData regarding the safety and efficacy of flow diverting stents (FDS) in the treatment of middle cerebral artery (MCA) bifurcation aneurysms are scarce and limited to small single center series, with particular concern for increased risk of ischemic complications with jailing one of the M2 branches.MethodsProspectively-maintained databases at six North American and European centers were queried for patients harboring MCA bifurcation aneurysms undergoing treatment with FDS (2011–2018). The pertinent clinical and radiographic data were collected and analyzed.Results87 patients (median age 60 years, 69% females) harboring 87 aneurysms were included. The majority of aneurysms were unruptured (79%); 75.9% were saccular with a median maximal diameter of 8.5 mm. Radiographic imaging follow-up was available in 88.5% of cases at a median of 16.3 months post-treatment, showing complete occlusion in 59% and near complete occlusion (90–99%) in 18% of aneurysms. The overall rate of ischemic and hemorrhagic complications was 8% and 1.1%, respectively. Symptomatic and permanent complications were encountered in 5.7% and 2.3% of patients respectively, with retreatment pursued in 2.3% of patients. Jailed branch occlusion was detected in 11.5% of cases, with clinical sequelae in 2.3%. Last follow-up modified Rankin Scale of 0–2 was noted in 96.8% of patients. On multivariate analysis, male sex was the only independent predictor of aneurysmal persistence at last follow-up imaging (p=0.019).ConclusionFDS treatment for MCA bifurcation aneurysms is feasible, with comparable safety and efficacy profiles to other available endovascular options when utilized in carefully selected aneurysms. Jailing of M2 branches was not associated with a higher risk of post-procedural ischemic complications.


2010 ◽  
Vol 67 (3) ◽  
pp. onsE313-onsE314 ◽  
Author(s):  
David Fiorella ◽  
Daniel Hsu ◽  
Henry H. Woo ◽  
Robert W. Tarr ◽  
Peter Kim Nelson

Abstract BACKGROUND: The Pipeline embolization device (PED) is a new endoluminal construct designed to exclude aneurysms from the parent cerebrovasculature. We report the very late (>;1 year) thrombosis of a PED construct placed for the treatment of a left vertebral aneurysm. CLINICAL PRESENTATION: A patient with an occluded right vertebral artery and a large, fusiform intracranial left vertebral artery aneurysm was treated with PED and coil reconstruction. A durable, complete occlusion of the aneurysm was confirmed with control angiography at 1 year. The patient remained neurologically normal for 23 months until he experienced a transient visual disturbance followed weeks later by a minor brainstem stroke. INTERVENTION: Imaging evaluation showed thrombosis of the PED construct with complete occlusion of the left vertebral artery. After this stroke, he was initially treated with dual antiplatelet therapy and was then converted to warfarin. The patient remained neurologically stable for 5 months until he experienced progressive basilar thrombosis that ultimately resulted in a fatal stroke. CONCLUSION: The PED represents a promising new endovascular technology for the treatment of cerebral aneurysms; however, as an investigational device, long-term follow-up data are sparse at this point. The etiology of the very late thrombosis of the PED construct in this case remains unknown; however, this report underscores the need for a continued, careful systematic evaluation and close long-term follow-up of treated patients.


PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7989 ◽  
Author(s):  
Iñaki Ruiz-Pérez ◽  
Alejandro López-Valenciano ◽  
Alejandro Jiménez-Loaisa ◽  
Jose L.L. Elvira ◽  
Mark De Ste Croix ◽  
...  

The main purpose of the current study was to analyze the injury incidence, characteristics and burden among sub-elite female futsal players. Individual exposure to match play and training, injury incidence and characteristics (player position, injury mechanism, type of injuries, severity of injuries, recurrent vs. new injuries, season variation of injury pattern) in a female futsal team were prospectively recorded for three consecutive seasons (2015–2018). Incidences were calculated per 1,000 h of exposure. A total of 30 injuries were reported during the three seasons within a total exposure of 4,446.1 h. The overall, match and training incidence of injuries were 6.7, 6.4 and 6.8 injuries/1,000 h of exposure, respectively. Most injuries had a non-contact mechanism (93%), with the lower extremity being the most frequently injured anatomical region (5.62 injuries/1,000 h of exposure). The most common type of injury was muscle/tendon (4.9 injuries/1,000 h of exposure) followed by joint (non-bone) and ligament (1.3 injuries/1,000 h of exposure). The injuries with the highest injury burden were those that occurred at the knee (31.9 days loss/1,000 h exposure), followed by quadriceps (15.3 day loss/1,000 h) and hamstring (14.4 day loss/1,000 h) strains. The first few weeks of competition after pre-season and soon after the Christmas break were the time points when most injuries occurred. These data indicate that sub-elite female futsal players are exposed to a substantial risk of sustaining an injury. To reduce overall injury burden, efforts should be directed toward the design, implementation and assessment of preventative measures that target the most common diagnoses, namely, muscle/tendon and ligament injuries.


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