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Pipeline embolization device

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https://www.readbyqxmd.com/read/28712897/safety-and-efficacy-of-a-600mg-loading-dose-of-clopidogrel-24-hours-before-pipeline-embolization-device-treatment
#1
Elias Atallah, Hassan Saad, Kimon Bekelis, Nohra Chalouhi, Stavropoula Tjoumakaris, David Hasan, Hekmat Zarzour, Michelle Smith, Robert H Rosenwasser, Pascal Jabbour
BACKGROUND: Clopidogrel/aspirin antiplatelet therapy is routinely administered 7 to 10 days prior to pipeline aneurysm treatment. Our study assessed the safety and efficacy of a 600mg loading dose of clopidogrel 24 hours before PED treatment. METHODS: We performed a retrospective cohort study involving patients treated with pipeline from October 2010 to May 2016. 39.7%(n=158) patients were dispensed a loading dose of 650mg of aspirin plus at least 600mg of clopidogrel 24 hours preceding PED deployment; 60...
July 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28710081/use-of-a-next-generation-multi-durometer-long-guide-sheath-for-triaxial-access-in-flow-diversion-experience-in-95-consecutive-cases
#2
Li-Mei Lin, Matthew T Bender, Geoffrey P Colby, Narlin B Beaty, Bowen Jiang, Jessica K Campos, Judy Huang, Rafael J Tamargo, Alexander L Coon
BACKGROUND: Intracranial access techniques in modern neurointerventions have shifted towards more robust access platforms. The long guide sheath is one of the building blocks of triaxial systems used in intracranial embolizations. Here we present our experience with the AXS Infinity LS long sheath in the triaxial platform for the implantation of the Pipeline embolization device (PED). METHODS: We retrospectively identified patients who underwent PED Flex treatment with the AXS Infinity LS at a single institution...
July 14, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28692909/pipeline-embolization-of-posterior-communicating-artery-aneurysms-associated-with-a-fetal-origin-posterior-cerebral-artery
#3
Adam N Wallace, Yasha Kayan, Matthew J Austin, Josser E Delgado Almandoz, Mudassar Kamran, DeWitte T Cross, Christopher J Moran, Joshua W Osbun, Akash P Kansagra
BACKGROUND AND PURPOSE: Flow diversion may have advantages in the treatment of posterior communicating artery (PComA) aneurysms associated with a fetal origin posterior cerebral artery (PCA), which can be challenging to treat with conventional techniques. However, a PComA incorporated into the aneurysm may prevent or delay aneurysm occlusion. Also, coverage of a fetal origin PCA risks infarction of a large vascular territory. The purpose of this study was to examine the safety and effectiveness of using the Pipeline Embolization Device (PED) to treat PComA aneurysms associated with a fetal origin PCA...
June 27, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28689183/acute-thrombus-formation-on-phosphorilcholine-surface-modified-flow-diverters
#4
Miklos Marosfoi, Frederic Clarencon, Erin T Langan, Robert M King, Olivia W Brooks, Takamisu Tamura, John M Wainwright, Matthew J Gounis, Srinivasan Vedantham, Ajit S Puri
PURPOSE: Thromboembolic complications remain a limitation of flow diverting stents. We hypothesize that phosphorilcholine surface modified flow diverters (Pipeline Flex with Shield Technology, sPED) would have less acute thrombus formation on the device surface compared with the classic Pipeline Embolization device (cPED). METHODS: Elastase-induced aneurysms were created in 40 rabbits and randomly assigned to receive cPED or sPED devices with and without dual antiplatelet therapy (DAPT) (four groups, n=10/group)...
July 8, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28638672/response-to-comment-on-failure-of-the-pipeline-embolization-device-in-posterior-communicating-artery-aneurysms-associated-with-a-fetal-posterior-cerebral-artery
#5
COMMENT
Mario Zanaty, Nohra Chalouhi, Robert M Starke, Pascal Jabbour, Katherine O Ryken, Ketan R Bulsara, David Hasan
No abstract text is available yet for this article.
2017: Case Reports in Vascular Medicine
https://www.readbyqxmd.com/read/28624566/4d-phase-contrast-mri-protocol-optimization-using-patient-specific-3d-printed-replicas-for-in-vivo-imaging-before-and-after-flow-diverter-placement
#6
Christof Karmonik, Jeff R Anderson, Saba Elias, Richard Klucznik, Orlando Diaz, Y Jonathan Zhang, Robert G Grossman, Gavin W Britz
PURPOSE: Hemodynamics in cerebral aneurysms is currently investigated towards its clinical efficacy using non-standardized computational simulation techniques. At the same time, flow patterns and velocities are accessible by 4D phase contrast magnetic resonance imaging (4D pcMRI). Complexity of protocol design and imaging duration has limited the use of this technique in clinical imaging. A new approach is presented to overcome these limitations. MATERIAL AND METHODS: 3D replicas of two cerebral aneurysms were fabricated by fused deposition prototyping (3D printing) and imaged using 4D pcMRI while connected to an MRI compatible continuous flow loop...
June 14, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28611839/utilization-of-a-novel-multi-durometer-intracranial-distal-access-catheter-nuances-and-experience-in-110-consecutive-cases-of-aneurysm-flow-diversion
#7
Geoffrey P Colby, Li-Mei Lin, Risheng Xu, Narlin Beaty, Matthew T Bender, Bowen Jiang, Judy Huang, Rafael J Tamargo, Alexander L Coon
BACKGROUND: Coaxial catheter support systems provide a safe and stable foundation in endovascular treatment of intracranial aneurysms. Increasingly, robust distal intracranial support is sought during complex neurointerventions. The AXS Catalyst 5 distal access catheter (Cat5) is a new intracranial catheter designed for improved trackability and stability. We report the first experience using Cat5 for aneurysm treatment by flow diversion. METHODS: A single-center aneurysm database was reviewed for cases of aneurysm treatment with the Pipeline embolization device (PED) that utilized Cat5...
March 2017: Interventional Neurology
https://www.readbyqxmd.com/read/28611831/salvage-of-herniated-flow-diverters-using-stent-and-balloon-anchoring-techniques-a-technical-note
#8
Bharathi D Jagadeesan, Divyajot Sandhu, Kim Jae Hong, Sara Roshan Khanipour, Andrew W Grande, Ramachandra P Tummala
BACKGROUND: The pipeline embolization device (PED; Medtronic, MN, USA) can sometimes herniate into the aneurysmal sac in an unexpected manner during or shortly after its deployment due to device foreshortening. In this report, we describe 2 endovascular techniques, which can be used to reposition a herniated PED construct into a more favorable alignment. SUMMARY: In a 67-year-old patient who had an intraprocedural herniation of a PED device into a giant cavernous aneurysm, a stent anchor technique was used to reverse the herniation, reorient the PED construct, and achieve successful flow diversion...
March 2017: Interventional Neurology
https://www.readbyqxmd.com/read/28595811/acute-distal-migration-of-a-flow-diverting-stent
#9
David Dornbos, Ciarán J Powers
The introduction of flow diverting stents, particularly for treatment of petrous to supraclinoid internal carotid artery aneurysms, has greatly impacted endovascular treatment of intracranial aneurysms. Despite their high efficacy, complications, such as ischemic events, distal hemorrhage, or problems with stent deployment, remain a significant concern. We present the first reported case of acute distal migration of a Pipeline Embolization Device (PED). A 24-year old female underwent elective placement of a PED for treatment of a left paraclinoid internal carotid artery aneurysm...
June 5, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28592484/analysis-of-neointima-development-in-flow-diverters-using-optical-coherence-tomography-imaging
#10
Yoshikazu Matsuda, Joonho Chung, Demetrius K Lopes
BACKGROUND: Flow diverters are used for the treatment of intracranial aneurysms. Surface modification may decrease the thrombogenicity of flow diverters but the details are unknown. Optical coherence tomography (OCT) is an intravascular imaging test with high resolution which identifies neointimal growth over stents. We compared the development of neointima in a flow diverter and stents with and without surface modification in a swine model. METHODS: In this study we implanted four devices (two in each carotid artery) in four pigs...
June 7, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28578117/pipeline-embolization-device-in-treatment-of-50-unruptured-large-and-giant-aneurysms
#11
Nimer Adeeb, Christoph J Griessenauer, Hussain Shallwani, Hakeem Shakir, Paul M Foreman, Justin M Moore, Adam Dmytriw, Raghav Gupta, Adnan H Siddiqui, Elad I Levy, Kenneth Snyder, Mark R Harrigan, Christopher S Ogilvy, Ajith J Thomas
INTRODUCTION: Treatment of large (≥ 20 mm) and giant (≥ 25 mm) intracranial aneurysms is challenging, and can be associated with a high rate of morbidity and mortality. The Pipeline Embolization Device (PED) has been effectively used for the treatment of intracranial aneurysms achieving a high rate of complete occlusion. However, its safety and efficacy in treatment of large and giant aneurysms has not been fully evaluated. METHODS: A retrospective analysis of consecutive aneurysms treated with PED between 2009 and 2016 at three academic institutions within the United States was performed...
May 31, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28565993/use-of-the-pipeline-embolization-device-in-the-treatment-of-iatrogenic-intracranial-vascular-injuries-a-bi-institutional-experience
#12
Julius Griauzde, Vijay M Ravindra, Neeraj Chaudhary, Joseph J Gemmete, Marcus D Mazur, Christopher D Roark, William T Couldwell, Min S Park, Philipp Taussky, Aditya S Pandey
OBJECTIVE Flow-diverting devices have been used for the treatment of complex intracranial vascular pathology with success, but the role of these devices in treating iatrogenic intracranial vascular injuries has yet to be clearly defined. Here, the authors report their bi-institutional experience with the use of the Pipeline embolization device (PED) for the treatment of iatrogenic intracranial vascular injuries. METHODS The authors reviewed a retrospective cohort of patients with iatrogenic injuries to the intracranial vasculature that were treated with the PED between 2012 and 2016...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565990/transcirculation-pipeline-embolization-device-deployment-a-rescue-technique
#13
Edison P Valle-Giler, Elias Atallah, Stavropoula Tjoumakaris, Robert H Rosenwasser, Pascal Jabbour
The Pipeline embolization device (PED) has become a very important tool in the treatment of nonruptured cerebral aneurysms. However, a patient's difficult anatomy or vascular stenosis may affect the device delivery. The purpose of this article was to describe an alternate technique for PED deployment when ipsilateral anatomy is not amenable for catheter navigation. A 44-year-old woman with a symptomatic 6-mm right superior hypophyseal artery aneurysm and a known history of right internal carotid artery dissection presented for PED treatment of her aneurysm...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565989/pipeline-embolization-device-for-recurrence-of-previously-treated-aneurysms
#14
David Dornbos, Constantine L Karras, Nicole Wenger, Blake Priddy, Patrick Youssef, Shahid M Nimjee, Ciarán J Powers
OBJECTIVE The 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...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565987/prolapse-of-the-pipeline-embolization-device-in-aneurysms-incidence-management-and-outcomes
#15
Visish M Srinivasan, Andrew P Carlson, Maxim Mokin, Jacob Cherian, Stephen R Chen, Ajit Puri, Peter Kan
OBJECTIVE The Pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, the PED has its own unique technical challenges, including the occurrence of device foreshortening or migration leading to prolapse into the aneurysm. The authors sought to determine the incidence of this phenomenon, the rescue strategies, and outcomes. METHODS Four institutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with PEDs...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565986/pipeline-embolization-device-versus-coiling-for-the-treatment-of-large-and-giant-unruptured-intracranial-aneurysms-a-cost-effectiveness-analysis
#16
Arvin R Wali, Charlie C Park, David R Santiago-Dieppa, Florin Vaida, James D Murphy, Alexander A Khalessi
OBJECTIVE Rupture of large or giant intracranial aneurysms leads to significant morbidity, mortality, and health care costs. Both coiling and the Pipeline embolization device (PED) have been shown to be safe and clinically effective for the treatment of unruptured large and giant intracranial aneurysms; however, the relative cost-to-outcome ratio is unknown. The authors present the first cost-effectiveness analysis to compare the economic impact of the PED compared with coiling or no treatment for the endovascular management of large or giant intracranial aneurysms...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565981/complications-associated-with-the-use-of-flow-diverting-devices-for-cerebral-aneurysms-a-systematic-review-and-meta-analysis
#17
Geng Zhou, Ming Su, Yan-Ling Yin, Ming-Hua Li
OBJECTIVE The objective of this study was to review the literature on the use of flow-diverting devices (FDDs) to treat intracranial aneurysms (IAs) and to investigate the safety and complications related to FDD treatment for IAs by performing a meta-analysis of published studies. METHODS A systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565980/update-on-flow-diverters-for-the-endovascular-management-of-cerebral-aneurysms
#18
Gary Rajah, Sandra Narayanan, Leonardo Rangel-Castilla
Flow diversion has become a well-accepted option for the treatment of cerebral aneurysms. Given the significant treatment effect of flow diverters, numerous options have emerged since the initial Pipeline embolization device studies. In this review, the authors describe the available flow diverters, both endoluminal and intrasaccular, addressing nuances of device design and function and presenting data on complications and outcomes, where available. They also discuss possible future directions of flow diversion...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565979/flow-diversion-of-tandem-cerebral-aneurysms-a-multi-institutional-retrospective-study
#19
Al-Wala Awad, Karam Moon, Nam Yoon, Marcus D Mazur, M Yashar S Kalani, Philipp Taussky, Cameron G McDougall, Felipe C Albuquerque, Min S Park
OBJECTIVE Flow diversion has proven to be an efficacious means of treating cerebral aneurysms that are refractory to other therapeutic means. Patients with tandem aneurysms treated with flow diversion have been included in larger, previously reported series; however, there are no dedicated reports on using this technique during a single session to treat this unique subset of patients. Therefore, the authors analyzed the outcomes of patients who had undergone single-session flow diversion for the treatment of tandem aneurysms...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565978/off-label-uses-of-the-pipeline-embolization-device-a-review-of-the-literature
#20
Purvee D Patel, Nohra Chalouhi, Elias Atallah, Stavropoula Tjoumakaris, David Hasan, Hekmat Zarzour, Robert Rosenwasser, Pascal Jabbour
The Pipeline embolization device (PED) is the most widely used flow diverter in endovascular neurosurgery. In 2011, the device received FDA approval for the treatment of large and giant aneurysms in the internal carotid artery extending from the petrous to the superior hypophyseal segments. However, as popularity of the device grew and neurosurgeons gained more experience, its use has extended to several other indications. Some of these off-label uses include previously treated aneurysms, acutely ruptured aneurysms, small aneurysms, distal circulation aneurysms, posterior circulation aneurysms, fusiform aneurysms, dissecting aneurysms, pseudoaneurysms, and even carotid-cavernous fistulas...
June 2017: Neurosurgical Focus
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