scholarly journals Immediate and follow-up results for 44 consecutive cases of small (<10 mm) internal carotid artery aneurysms treated with the pipeline embolization device

2013 ◽  
Vol 4 (1) ◽  
pp. 114 ◽  
Author(s):  
AlexanderL Coon ◽  
Li-Mei Lin ◽  
GeoffreyP Colby ◽  
JenniferE Kim ◽  
Judy Huang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Pipeline Embolization Device

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

2017 ◽  
Vol 23 (6) ◽  
pp. 614-619 ◽  
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.

Pipeline embolization device treatment of internal carotid artery terminus aneurysms

2018 ◽  
Vol 11 (5) ◽  
pp. 485-488 ◽  
Author(s):  
Amit Pujari ◽  
Brian Matthew Howard ◽  
Thomas P Madaelil ◽  
Susana Libhaber Skukalek ◽  
Anil K Roy ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Maximum Diameter ◽  
Class Iii ◽  
Pipeline Embolization Device ◽  
Proximal Internal Carotid Artery ◽  
The Mean

BackgroundThe pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied.MethodsWe conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded.ResultsMean age was 46.9 years (± 8.8), and 6 (60%) patients were women. The mean maximum diameter of the aneurysms treated was 14.7 mm (± 10.7) and the mean neck diameter was 9.3 mm (± 6.6). Reasons for presentation included six incidental findings, one acute subarachnoid hemorrhage (SAH), and three patients with prior SAH. Kamran–Byrne Occlusion Scale scores for the treated aneurysms were as follows: three class IV (complete obliteration), four class III (<50% filling in both height and width for fusiform aneurysms or residual neck for saccular aneurysms), one class II fusiform aneurysm, 1 class 0 saccular aneurysm (residual aneurysm body), and one not classified due to pipeline thrombosis. Two clinically asymptomatic complications were noted: one patient who had a small distal cortical SAH post PED and one patient whose stent was found to be thrombosed on follow-up angiogram. All patients were seen in follow-up, and no patients were found to have worsening of their pre-procedure modified Rankin Scale score.ConclusionThe PED has potential for treating ICA-T aneurysms not amenable to conventional treatment strategies. Further studies are warranted to confirm the long term outcomes.

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

2018 ◽  
Vol 25 (1) ◽  
pp. 4-11 ◽  
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.

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

2019 ◽  
Vol 10 (01) ◽  
pp. 142-144 ◽  
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.

scholarly journals Unruptured giant intracavernous aneurysms untolerate internal carotid artery occlusion test: Untreated and treated with flow-diversion

2020 ◽  
Vol 33 (2) ◽  
pp. 105-111
Author(s):  
Xianli Lv ◽  
Jianjun Yu ◽  
Ting Liao ◽  
Jin Wang ◽  
Guihuai Wang
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Cranial Neuropathy ◽  
Pipeline Embolization Device ◽  
Occlusion Test

Background and objective Giant intracavernous aneurysms (GICAs) are located in extradural space; their clinical manifestation and treatment are different from other intradural aneurysms. This study reports clinical outcomes of GICAs untolerate internal carotid artery occlusion tests. Methods Between January 2012 and September 2017, 14 consecutive cases of GICAs untolerated internal carotid artery occlusion test were retrospectively reviewed. A total of nine patients were not treated and five patients were treated using a Pipeline Embolization Device. Results Of the 14 patients, 12 had compression symptoms and 2 were incidental. In nine untreated patients, during 34 months' (range, 7–64 months) follow-up, four worsened to headaches or ablepsia (more than 34 months). One patient, who presented with ophthalmoplegia and diplopia, showed spontaneous resolution of symptoms at 32-month follow-up. Symptoms in four patients remained unchanged during less than 36-month follow-up period. In five (100%, 95% confidence interval 57% to 100%) treated patients, symptoms recovered completely during 11 months' follow-up after transient worsening of mass compression. Conclusions GICAs frequently result in intractable cranial neuropathy requiring treatment. The Pipeline Embolization Device is an effective option for these complex aneurysms in selective cases.

scholarly journals Long-Term Clinical and Angiographic Outcomes Following Pipeline Embolization Device Treatment of Complex Internal Carotid Artery Aneurysms: Five-Year Results of the Pipeline for Uncoilable or Failed Aneurysms Trial

Neurosurgery ◽  
2016 ◽  
Vol 80 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Tibor Becske ◽  
Waleed Brinjikji ◽  
Matthew B. Potts ◽  
David F. Kallmes ◽  
Maksim Shapiro ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Multicenter Trial ◽  
Modified Rankin Scale ◽  
Pipeline Embolization Device ◽  
Cerebrovascular Events ◽  
Scale Scores ◽  
Aneurysm Occlusion

Abstract BACKGROUND: Early and mid-term safety and efficacy of aneurysm treatment with the Pipeline Embolization Device (PED) has been well demonstrated in prior studies. OBJECTIVE: To present 5-yr follow-up for patients treated in the Pipeline for Uncoilable or Failed Aneurysms clinical trial. METHODS: In our prospective, multicenter trial, 109 complex internal carotid artery (ICA) aneurysms in 107 subjects were treated with the PED. Patients were followed per a standardized protocol at 180 d and 1, 3, and 5 yr. Aneurysm occlusion, in-stent stenosis, modified Rankin Scale scores, and complications were recorded. RESULTS: The primary endpoint of complete aneurysm occlusion at 180 d (73.6%) was previously reported. Aneurysm occlusion for those patients with angiographic follow-up progressively increased over time to 86.8% (79/91), 93.4% (71/76), and 95.2% (60/63) at 1, 3, and 5 yr, respectively. Six aneurysms (5.7%) were retreated. New serious device-related events at 1, 3, and 5 yr were noted in 1% (1/96), 3.5% (3/85), and 0% (0/81) of subjects. There were 4 (3.7%) reported deaths in our trial. Seventy-eight (96.3%) of 81 patients with 5-yr clinical follow-up had modified Rankin Scale scores ≤2. No delayed neurological deaths or hemorrhagic or ischemic cerebrovascular events were reported beyond 6 mo. No recanalization of a previously occluded aneurysm was observed. CONCLUSION: Our 5-yr findings demonstrate that PED is a safe and effective treatment for large and giant wide-necked aneurysms of the intracranial ICA, with high rates of complete occlusion and low rates of delayed adverse events.

Pipeline Embolization Device for Treatment of Extracranial Internal Carotid Artery Pseudoaneurysms: A Multicenter Evaluation of Safety and Efficacy

Neurosurgery ◽  
2020 ◽  
Vol 87 (4) ◽  
pp. 770-778
Author(s):  
Oluwaseun O Akinduro ◽  
Neethu Gopal ◽  
Tasneem F Hasan ◽  
Emad Nourollah-Zadeh ◽  
Kunal Vakharia ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Case Series ◽  
The United States ◽  
Pipeline Embolization Device ◽  
Safety And Efficacy ◽  
Complete Occlusion ◽  
Extracranial Ica

Abstract BACKGROUND There is a paucity of literature regarding treatment options for extracranial pseudoaneurysms of the internal carotid artery (ICA). To date, Pipeline Embolization Device (PED; Medtronic Inc) use for the treatment of extracranial pseudoaneurysms of the ICA has only been reported from single-center case series. OBJECTIVE To evaluate the safety and efficacy of PED for the treatment of extracranial ICA pseudoaneurysms. METHODS This is a multicenter retrospective study involving 6 high-volume tertiary academic institutions in the United States. We analyzed patients with extracranial ICA pseudoaneurysms treated with PED between January 1, 2011, and January 1, 2019. Clinical assessment was performed pre- and postintervention using the modified Rankin Scale (mRS) and National Institution of Health Stroke Scale (NIHSS) at a minimum of 4-mo follow-up. RESULTS A total of 28 pseudoaneurysms with a mean diameter of 17.7 mm (range: 4.1-52.5 mm) were treated with PED in 24 patients at 6 participating centers. The mean age was 52.1 yr (17-73) ± 14.3 with 14 females and 10 males. At a mean of 21-mo (range 4-66 mo) follow-up, complete occlusion was achieved in 89% (n = 25/28), with near-complete occlusion (&gt;90% occlusion) in the remainder. There were no periprocedural complications. Postprocedure NIHSS was 0 in 88% (n = 21/24) and 1 in 12% (n = 3/24) of patients, and mRS was 0 in 83% (n = 20/24) and 1 in 17% (n = 4/24) of patients. CONCLUSION The treatment of extracranial ICA pseudoaneurysms with PED is safe and effective in selected patients. Randomized controlled trials and prospective cohort studies are needed to establish the role of flow diversion for ICA pseudoaneurysms.

Incidence and Clinical Implications of Carotid Branch Occlusion Following Treatment of Internal Carotid Artery Aneurysms With the Pipeline Embolization Device

Neurosurgery ◽  
2014 ◽  
Vol 76 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Aditya Vedantam ◽  
Vikas Y. Rao ◽  
Hashem M. Shaltoni ◽  
Michel E. Mawad
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Side Branch ◽  
Neurological Deficits ◽  
Pipeline Embolization Device ◽  
Anterior Choroidal ◽  
Choroidal Artery ◽  
Flow Diverters

ABSTRACT BACKGROUND: The use of flow diverters such as the pipeline embolization device (PED) for treatment of intracranial aneurysms carries the risk of side branch occlusion. OBJECTIVE: To determine the incidence and clinical outcomes associated with supraclinoid internal carotid artery (ICA) branch occlusion after deployment of PEDs for ICA aneurysms. METHODS: We reviewed patients who underwent endovascular treatment with PEDs for ICA aneurysms between June 2011 and March 2013. Forty-nine patients (43 women, mean age 56.3 ± 1.8 years, 68 aneurysms) in whom PEDs traversed the origin of supraclinoid ICA branches (ophthalmic [OA], posterior communicating [PcommA], and anterior choroidal artery [AChA]) were selected for this study. Follow-up angiograms (mean follow-up, 12.8 ± 0.8 months) were studied to determine the location of PEDs and the patency of ICA branches. RESULTS: PEDs were placed across the ostia of 49 OAs, 14 PcommAs, and 11 AChAs. Multiple PEDs were deployed in 16 patients. Rate of branch occlusion was 4% (2/49) for the OA, 7.1% (1/14) for the PcommA, and 0% for the AChA. Patients with branch occlusion did not endure new neurological deficits. ICA branch occlusion was not associated with the number of PEDs covering the ostia (P = .76) or the origin of ICA branches from the aneurysm (P = .24). CONCLUSION: The incidence of major supraclinoid ICA branch occlusion after treatment with PEDs was low. These events were not associated with new neurological deficits nor were they related to the number of PEDs deployed or the origin of ICA branches from the aneurysm.

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