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Pipeline embolization device

Maus Volker, Mpotsaris Anastasios, Borggrefe Jan, Abdullayev Nuran, Liebig Thomas, Dorn Franziska, Stavrinou Pantelis, Chang De-Hua, Kabbasch Christoph
Purpose: The aim of this study was to evaluate the technical feasibility and rate of mid-term occlusion in aneurysms treated solely with the Pipeline Embolization Device (PED) in a German tertiary care university hospital. Materials and Methods: Forty-nine non-consecutive intracranial aneurysms underwent endovascular treatment using the PED exclusively between March 2011 and May 2017 at our institution. Primary endpoint was a favorable aneurysm occlusion defined as OKM C1-3 and D (O'Kelly Marotta Scale)...
March 2018: Neurointervention
Adam A Dmytriw, Nimer Adeeb, Ashish Kumar, Christoph J Griessenauer, Kevin Phan, Christopher S Ogilvy, Paul M Foreman, Hussain Shallwani, Nicola Limbucci, Salvatore Mangiafico, Caterina Michelozzi, Timo Krings, Vitor Mendes Pereira, Charles C Matouk, Yuchen Zhang, Mark R Harrigan, Hakeem J Shakir, Adnan H Siddiqui, Elad I Levy, Leonardo Renieri, Christophe Cognard, Ajith J Thomas, Thomas R Marotta
BACKGROUND: Flow diversion for basilar apex aneurysms has rarely been reported. OBJECTIVE: To assess flow diversion for basilar apex aneurysms in a multicenter cohort. METHODS: Retrospective review of prospectively maintained databases at 8 academic institutions was performed from 2009 to 2016 to identify patients with basilar apex aneurysms treated with flow diversion. Clinical and radiographic data were analyzed. RESULTS: Sixteen consecutive patients (median age 54...
February 26, 2018: Neurosurgery
Adam N Wallace, Jonathan A Grossberg, Josser E Delgado Almandoz, Mudassar Kamran, Anil K Roy, Yasha Kayan, Matthew J Austin, Brian M Howard, Christopher J Moran, C Michael Cawley, DeWitte T Cross, Jacques E Dion, Akash P Kansagra, Joshua W Osbun
BACKGROUND: Flow diversion of posterior cerebral artery (PCA) aneurysms has not been widely reported, possibly owing to concerns regarding parent vessel size and branch vessel coverage. OBJECTIVE: To examine the safety and effectiveness of PCA aneurysm flow diverter treatment. METHODS: Retrospective review of PCA aneurysms treated with the Pipeline Embolization Device (PED; Medtronic Inc, Dublin, Ireland) at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes...
March 8, 2018: Neurosurgery
Wonsoo Son, Dong-Hun Kang, Byung Moon Kim, Jaechan Park, Yong-Sun Kim
BACKGROUND: The pipeline embolization device (PED; ev3, Irvine, California, USA) has been used to divert flow away from an aneurysm sac. The risk of complications may increase for flow diversion with giant aneurysms, since these cases may require multiple overlapping PEDs, which makes the technique highly complex. CASE DESCRIPTION: We report a rescue technical strategy for lost access during multiple overlapping PED placement for a giant, fusiform cavernous aneurysm...
March 7, 2018: World Neurosurgery
Nohra Chalouhi, Purvee D Patel, Elias Atallah, Robert M Starke, Ameet Chitale, Michael Lang, Stavropoula Tjoumakaris, David Hasan, Hekmat Zarzour, Michelle J Smith, Robert Rosenwasser, Pascal Jabbour
BACKGROUND: Flow diversion has emerged as a highly effective treatment for intracranial aneurysms. OBJECTIVE: To assess the yield of further angiographic follow-up in aneurysms that have achieved adequate occlusion after treatment with the Pipeline Embolization Device (PED; Medtronic Inc, Dublin, Ireland). METHODS: This is a single-institution, retrospective study. Inclusion criteria were as follows: (1) patients with 1 or more aneurysms treated with PED, (2) available short-term (<12 mo) follow-up digital subtraction angiography (DSA), (3) complete (100%) or near-complete (>95%) occlusion on short-term follow-up DSA, and (4) available further angiographic follow-up (DSA, Magnetic Resonance Angiography (MRA), or Computed Tomography Angiography (CTA))...
March 5, 2018: Neurosurgery
Rajsrinivas Parthasarathy, Vipul Gupta, Aditya Gupta
OBJECTIVES: Blister like aneurysm (BLA) is extremely challenging to treat; endoluminal reconstruction has emerged as the most promising treatment method. When to treat after the ictus, the timing of administration of antiplatelet and causal relationship between platelet function testing results and thromboembolism is unclear. We theorized that Prasugrel with a lower incidence of resistance may be a safe suitable alternative to clopidogrel in patients treated with a flow diverter. METHODS: Prospectively collected data from consecutive patients treated for a ruptured blister with a flow diverter was reviewed...
March 6, 2018: British Journal of Radiology
Ali S Haider, Tijani Osumah, Hawk Cambron, Suraj Sulhan, Fariha Murshid, Steven Vayalumkal, Richa Thakur, Umair Khan, Kennith F Layton
The two main treatment modalities of acute intracranial aneurysm rupture are endovascular embolization and surgical clipping, each with its own benefits and risks. Endovascular treatment is associated with better outcomes compared to surgical clipping, but is also associated with high recurrence rates. We present the case of a patient with an acutely ruptured intracranial aneurysm, who subsequently underwent partial endovascular coiling acutely, and later underwent flow diversion therapy with the Pipeline Embolization Device...
November 25, 2017: Curēus
Maxim Mokin, Angel Chinea, Christopher T Primiani, Zeguang Ren, Peter Kan, Visish M Srinivasan, Ricardo Hanel, Pedro Aguilar-Salinas, Aquilla S Turk, Raymond D Turner, M Imran Chaudry, Andrew J Ringer, Babu G Welch, Vitor Mendes Pereira, Leonardo Renieri, Mariangela Piano, Lucas Elijovich, Adam S Arthur, Ahmed Cheema, Demetrius Klee Lopes, Ahmed Saied, Blaise W Baxter, Harris Hawk, Ajit S Puri, Ajay K Wakhloo, Hussain Shallwani, Elad I Levy, Adnan H Siddiqui, Guilherme Dabus, Italo Linfante
BACKGROUND: Blood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective. OBJECTIVE: To report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA). METHODS: Consecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis...
February 24, 2018: Journal of Neurointerventional Surgery
Philippe Dodier, Josa M Frischer, Wei-Te Wang, Thomas Auzinger, Ammar Mallouhi, Wolfgang Serles, Andreas Gruber, Engelbert Knosp, Gerhard Bavinzski
OBJECTIVE: The authors report long-term results after PED implantation, characterize complex and standard aneurysms comprehensively and introduce a modified flow disruption scale. METHODS: The authors retrospectively reviewed a consecutive series of 40 patients, harboring 59 aneurysms treated with 54 PEDs. Aneurysm complexity was assessed using our proposed classification. Immediate angiographic results were analyzed using previously published grading scales and our novel flow disruption scale (BD scale)...
February 22, 2018: World Neurosurgery
Anna Luisa Kühn, Guilherme Dabus, Peter Kan, Ajay K Wakhloo, Ajit S Puri
Background Use of flow-diversion technology in the treatment of incidental and recanalized posterior communicating artery (PComA) aneurysms. Methods Patients treated with the Pipeline embolization device (PED) for PComA aneurysms were identified and included in our retrospective analysis. We evaluated aneurysm characteristics, modified Rankin Scale score (mRS) on admission, angiography follow-up, and patient clinical outcome at discharge, at three to nine months, and at 12-18 months. Results We included 56 patients with a mean age of 56 years...
January 1, 2018: Interventional Neuroradiology
NiZaMiDingJiang ReXiaTi, ReXiDan AiKeReMu, KaHeErMan KaDeEr, Yan-Dong Fan, Zhao-Hai Feng, Kai Wang, TeWuErBaTi SuErTanNiYa, Tao-Tao Dou, Hai-Qiang Wu, MaiMaiTiLi AiSha, Xiao-Jiang Cheng
OBJECTIVE: To observe the short-term efficacy of Pipeline embolization divice (PED) for the treatment of complex intracranial aneurysms. METHODS: The clinical data of 29 consecutive patients with 32 intracranial aneurysms treated with PED between April 2015 to September 2016 were analyzed retrospectively. There were 3 small aneurysm, 15 large aneurysms, 8 giant aneurysms, 5 fusiform ayneurysms and 1 recidivation. The vessels include 25 anterior circulation and 4 posterior circulation...
2018: Bio-medical Materials and Engineering
Anna M Schneider, Justin M Moore, Nimer Adeeb, Raghav Gupta, Christoph J Griessenauer, Peter A Winkler, Sarah Sieber, Abdulrahman Y Alturki, Christopher S Ogilvy, Ajith J Thomas
INTRODUCTION: The objective of this study was to analyze patients' perceptions of their headaches both prior to and following Pipeline flow diversion treatment of their unruptured intracranial aneurysms, with the goal of identifying prognostic factors associated with headache patterns to improve predictions of overall outcomes. MATERIALS AND METHODS: We retrospectively identified 133 patients treated with the PED between January 1 st 2014 and December 31 st 2016 at an academic institution in the United States...
February 14, 2018: World Neurosurgery
Denise Brunozzi, Sophia F Shakur, Fady T Charbel, Ali Alaraj
Objective Pipeline embolization devices (PED) are commonly used for endovascular treatment of cerebral aneurysms but changes in intracranial hemodynamics after PED deployment are poorly understood. Here, we assess middle cerebral artery (MCA) and systemic blood pressure before and after PED treatment. Methods Records of patients with cerebral aneurysms proximal to the internal carotid artery terminus treated with PED at our institution between 2015 and 2017 were retrospectively reviewed. Patients were included if ipsilateral MCA pressure measurements were available...
January 1, 2018: Interventional Neuroradiology
Nimer Adeeb, Raghav Gupta, Anna M Schneider, Madeline Leadon, Alejandro Enriquez, Christoph J Griessenauer, Mohammad Salem, Abdulrahman Alturki, Philip Schmalz, Christopher S Ogilvy, Ajith J Thomas, Justin M Moore
BACKGROUND: The choice of appropriate antiplatelet therapy prior to the Pipeline Embolization Device (PED) placement is usually guided by platelet function testing such as light transmission aggregometry (LTA). In this study, we aimed to define the optimal threshold LTA value for clopidogrel responsiveness to predict the risk of post-procedural thromboembolic complications and to help guide appropriate antiplatelet regimen. MATERIALS AND METHODS: A prospectively maintained database at an academic neurosurgical center in the United States was retrospectively analyzed from 2014 to 2017 to identify patients with unruptured intracranial aneurysms treated with the PED...
February 6, 2018: World Neurosurgery
Fei Liang, Yupeng Zhang, Feng Guo, Yuxiang Zhang, Peng Yan, Shikai Liang, Yuhua Jiang, Peng Jiang, Chuhan Jiang
OBJECTIVE: To evaluate the performance of PED for posterior circulation aneurysms. METHODS: From November 2015 to November 2016, 35 patients with 38 posterior circulation aneurysms were treated with PED in this retrospective study. We evaluated the angiographic and clinical outcomes of these aneurysms at last follow-up, and made a comparison between anterior (N=163) and posterior circulation aneurysms regarding the technical nuances, occlusion rate, complications rate and time to occlusion to explore whether we should rationalize the use of PED for these aneurysms...
February 1, 2018: World Neurosurgery
Kirill Orlov, Dmitry Kislitsin, Nikolay Strelnikov, Vadim Berestov, Anton Gorbatykh, Timur Shayakhmetov, Pavel Seleznev, Anton Tasenko
Utilization of flow diverting devices is accompanied with dual antiplatelet therapy to reduce the risk of thromboembolic events, even though this increases the risk of hemorrhagic complications. The updated Pipeline Flex embolization device with Shield Technology has been created using a phosphorylcholine coating that reduces thrombogenicity and possibly reduces the need for dual antiplatelet therapy. However, because of the potential risk to patients of utilizing a pipeline embolization device without dual antiplatelet therapy, the pipeline embolization device with Shield Technology has not been tested in human subjects without dual antiplatelet therapy, and its contribution to preventing thromboembolic events is therefore unknown...
January 1, 2018: Interventional Neuroradiology
Hidenori Oishi, Kosuke Teranishi, Kenji Yatomi, Munetaka Yamamoto, Hajime Arai
A delayed aneurysm rupture after flow diverter therapy is a rare but serious complication. Due to the anatomical specificity, a delayed rupture of a carotid cavernous aneurysm may cause a direct carotid cavernous fistula (dCCF). We present a novel therapeutic approach for treatment of dCCF after flow diverter therapy using the Pipeline embolization device (PED). An 86-year-old woman suffered from dCCF after PED embolization. A microcatheter was advanced through the transvenous approach into the cavernous sinus (CS) and further inserted into the aneurysm sac via the rupture point...
January 2018: NMC Case Report Journal
Geoffrey P Colby, Matthew T Bender, Li-Mei Lin, Narlin Beaty, Justin M Caplan, Bowen Jiang, Erick M Westbroek, Bijan Varjavand, Jessica K Campos, Judy Huang, Rafael J Tamargo, Alexander L Coon
OBJECTIVE The second-generation Pipeline embolization device (PED), Flex, has several design upgrades, including improved opening and the ability to be resheathed, in comparison with the original device (PED classic). The authors hypothesized that Flex is associated with a lower rate of major complications. METHODS A prospective, IRB-approved, single-institution database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion. The PED classic was used from August 2011 to January 2015, and the Pipeline Flex has been used since February 2015...
January 12, 2018: Journal of Neurosurgery
Kyle Davis, Christopher Morrison
BACKGROUND: The development of thromboembolism is one of the most common complications of neuroendovascular procedures. Although several small studies have deemed clopidogrel safe and effective in the prevention of intracranial stent thrombosis, ticagrelor has yet to be assessed in this setting. OBJECTIVE: The objective of this study was to retrospectively evaluate the safety and efficacy of ticagrelor in patients undergoing neuroendovascular procedures. METHODS: A retrospective review of patients receiving ticagrelor following neuroendovascular aneurysm repair...
January 1, 2017: Journal of Pharmacy Practice
Denise Brunozzi, Sophia F Shakur, Fady T Charbel, Ali Alaraj
Background Pipeline embolization devices (PEDs) are used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral intraparenchymal hemorrhage (DIPH). Changes in intracranial hemodynamics after PED are poorly understood. Objective Here, we assess hemodynamic changes after PED in patients and compare these changes in patients with and without DIPH (DIPH+ and DIPH-). Methods Records of patients with distal internal carotid artery (ICA) aneurysms treated with PED at our institution between 2012 and 2017 were retrospectively reviewed...
April 2018: Interventional Neuroradiology
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