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Pipeline embolization device

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https://www.readbyqxmd.com/read/29327999/declining-complication-rates-with-flow-diversion-of-anterior-circulation-aneurysms-after-introduction-of-the-pipeline-flex-analysis-of-a-single-institution-series-of-568-cases
#1
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
https://www.readbyqxmd.com/read/29279045/ticagrelor-for-neuroendovascular-procedures-a-case-series
#2
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
https://www.readbyqxmd.com/read/29231794/intracranial-contrast-transit-times-on-digital-subtraction-angiography-decrease-more-in-patients-with-delayed-intraparenchymal-hemorrhage-after-pipeline
#3
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...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29219758/the-use-of-alternatives-to-clopidogrel-in-flow-diversion-treatment-with-the-pipeline-embolization-device
#4
Elias Atallah, Hassan Saad, Kimon Bekelis, Nohra Chalouhi, Stavropoula Tjoumakaris, David Hasan, Jorge Eller, David Stidd, Robert H Rosenwasser, Pascal Jabbour
OBJECTIVE Thromboembolic complications continue to be encountered with Pipeline embolization devices (PEDs) despite routine clopidogrel/aspirin antiplatelet therapy. This study examined the safety and efficacy of prasugrel in the management of clopidogrel-resistant patients treated for cerebral aneurysms. METHODS Four hundred thirty-seven consecutive patients were identified between January 2011 and May 2016. Patients allergic, or having less than 30% platelet inhibition, to a daily 75-mg dose of clopidogrel received 10 mg of prasugrel daily (n = 20) or 90 mg of ticagrelor twice daily (n = 2)...
December 8, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29204036/flow-diverting-stent-assisted-coil-embolization-of-a-ruptured-internal-carotid-artery-blister-aneurysm-with-the-pipeline-flex-embolization-device
#5
Dale Ding, Robert M Starke, Ayton Hope, Stefan Brew
Internal carotid artery (ICA) blister aneurysms are rare and challenging to successfully treat, using contemporary surgical or endovascular approaches, without partial or complete compromise of the parent vessel. We describe the use of a resheathable flow diverter, the Pipeline Flex Embolization Device (PFED) to perform stent-assisted coiling of a ruptured supraclinoid ICA blister aneurysm in a 56-year-old female who presented with a high-grade subarachnoid hemorrhage (SAH). The first PFED was deployed across the aneurysm neck to jail a microcatheter within the aneurysm dome, and then, two small coils were delivered into the aneurysm...
October 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/29201581/contrast-enhancement-of-aneurysm-sac-post-pipeline-treatment-interpreted-as-recanalization
#6
Annie J Tsay, Sara Langan, Scott Simon
Multiple imaging modalities are available to evaluate aneurysms post-flow diverter (FD) placement. Though digital subtraction angiography (DSA) is the gold standard imaging modality post-FD placement, it is not perfect, and neither are other techniques, including contrast-enhanced magnetic resonance angiography (CE-MRA) and magnetic resonance imaging (MRI). We present a case of a 73-year-old woman with a right internal carotid artery (ICA) aneurysm treated with a pipeline embolization device (PED). Initial follow-up post-PED placement by three-dimensional time-of-flight (3D-TOF) MRA demonstrated aneurysm occlusion, which was confirmed by computed tomography angiography (CTA) and CE-MRA in subsequent follow-up appointments...
September 29, 2017: Curēus
https://www.readbyqxmd.com/read/29174523/transvenous-coil-embolization-for-the-treatment-of-carotid-cavernous-fistula-after-pipeline-placement-a-case-report
#7
Ryuta Nakae, Masaya Nagaishi, Issei Takano, Yoshihiro Tanaka, Akio Hyodo, Kensuke Suzuki
The Pipeline embolization device (PED), a type of flow diverter, has become an appealing alternative treatment option for large or giant and wide-necked intracranial aneurysms. Carotid cavernous fistula (CCF) resulting from delayed aneurysmal rupture is a rare complication of PED placement with unknown pathophysiology. Here, we describe a case of CCF resulting from aneurysmal rupture following PED placement, and present the details of treatment by transvenous coil embolization. An 81-year-old woman was referred to our hospital for treatment of an 18...
November 22, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29163748/transradial-approach-for-deployment-of-a-flow-diverter-for-an-intracranial-aneurysm-in-a-patient-with-a-type-3-aortic-arch
#8
Geoffrey W Peitz, Bhavani Kura, Jeremiah N Johnson, Ramesh Grandhi
Background: Flow diversion with the Pipeline embolization device (PED) is an effective treatment for giant and wide-neck intracranial aneurysms, but the standard transfemoral approach may not be feasible in patients with Type-3 aortic arches. Case Report: An 84-year-old woman presented with a right internal carotid artery (ICA) giant aneurysm and a Type-3 aortic arch, necessitating a transradial approach for access to the right common carotid artery. A triaxial catheter system made for a stable platform for the deployment of two telescoping PEDs to treat the patient's right ICA giant aneurysm...
October 2017: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/29140523/sequential-coiling-assisted-deployment-of-flow-diverter-for-treatment-of-fusiform-middle-cerebral-artery-aneurysms
#9
Abdulrahman Y Alturki, Philip G R Schmalz, Christopher S Ogilvy, Ajith J Thomas
BACKGROUND AND IMPORTANCE: Fusiform intracranial aneurysms remain challenging lesions to treat. These aneurysms have historically required bypass procedures or clip remodeling constructs for cure. Recently, endovascular specialists have reported experience with flow diversion for complex fusiform aneurysms of the vertebrobasilar system, with mixed results. Vascular anatomy for anterior circulation fusiform aneurysms may make these lesions more amenable to flow diversion and embolization procedures; however, published experience with these techniques is lacking...
November 11, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29118792/anchoring-pipeline-flow-diverter-construct-in-the-treatment-of-traumatic-distal-cervical-carotid-artery-injury
#10
Krishna Amuluru, Fawaz Al-Mufti, William Roth, Charles J Prestigiacomo, Chirag D Gandhi
Background: Traumatic extracranial internal carotid artery (ICA) dissections are uncommon and can be difficult to treat. Thinning of adventitia and dilatation may occur following arterial dissection, thus resulting in a fusiform pseudoaneurysm, which can subsequently cause bleeding, expanding, or pulsatile hematoma. Currently, medical management with anticoagulation remains the first line of treatment and yields good outcomes in 75% of cases with a mortality rate of 3-4%. Endovascular intervention is indicated with failure of medical therapy, progressive enlargement of a traumatic pseudoaneurysm, acute flow-related infarcts due to vessel occlusion, or when anticoagulation is contraindicated due to risk of pseudoaneurysm rupture and hemorrhage...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29118790/rescue-treatment-with-pipeline-embolization-for-postsurgical-clipping-recurrences-of-anterior-communicating-artery-region-aneurysms
#11
Li-Mei Lin, Rajiv R Iyer, Matthew T Bender, Thomas Monarch, Geoffrey P Colby, Judy Huang, Rafael J Tamargo, Alexander L Coon
Background: Postsurgical clipping aneurysm recurrences or residuals can be difficult to manage with either traditional open microsurgical approaches or endosaccular coiling. Endoluminal parent vessel reconstruction with flow diversion may be an ideal method for treating these recurrences by avoiding reoperative surgery or intraprocedural aneurysm rupture with aneurysm access. Method: We retrospectively reviewed a single-center aneurysm database identifying all anterior communicating artery (ACom) region aneurysms with recurrences after microsurgical clipping...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29118789/anterior-communicating-artery-aneurysm-treatment-with-the-pipeline-embolization-device-a-single-center-experience-with-long-term-follow-up
#12
Ali Sultan-Qurraie, Ahsan Sattar, Wled Wazni, Mazen Noufal, Osama Zaidat
Introduction: The pipeline embolization device (PED) is increasingly used in the endovascular management of cerebral aneurysms. Longitudinal data regarding safety and benefit of the PED in anterior communicating (ACOM) artery aneurysms are limited and particularly lacking in residual ACOM artery aneurysms. We report the use of the PED in 3 patients with ACOM artery aneurysms who were previously coiled. Methods: Three patients with ACOM artery aneurysms, all previously treated with coiling and with recurrence of the aneurysm neck, were treated with the PED...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29089414/flow-diversion-for-anterior-choroidal-artery-acha-aneurysms-a-multi-institutional-experience
#13
Visish M Srinivasan, Michael George Zaki Ghali, Jacob Cherian, Maxim Mokin, Ajit S Puri, Ramesh Grandhi, Stephen R Chen, Jeremiah N Johnson, Peter Kan
BACKGROUND: Anterior choroidal artery (AChA) aneurysms represent a small subset of cerebral aneurysms. The Pipeline Embolization Device (PED) has been successfully applied to various aneurysms of the supraclinoid internal carotid artery (ICA). The treatment of these aneurysms requires special attention due to the eloquent territory supplied by the AChA. We report the largest and first dedicated series of flow diversion treatment of AChA aneurysms. METHODS: Four institutional neurointerventional databases were reviewed for cases of intracranial aneurysms treated with PED...
October 31, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29081013/emerging-technologies-in-flow-diverters-and-stents-for-cerebrovascular-diseases
#14
REVIEW
Michael Karsy, Jian Guan, Andrea A Brock, Anubhav Amin, Min S Park
PURPOSE OF REVIEW: Stents and flow diverters have revolutionized the treatment of cerebrovascular disease. Guglielmi coils, flexible microcatheters, and first-generation intracranial stents, such as Neuroform (Stryker Neurovascular) and Enterprise stents (Codman/DePuy-Synthes), have paved the way for the development of the Pipeline Embolization Device (PED) (ev3/Covidien/Medtronic) and other endovascular approaches. RECENT FINDINGS: This review discusses the historical development of flow diverter technologies from the PED to similar devices, such as the Surpass stent (Stryker Neurovascular), the Flow-Redirection Endoluminal Device (FRED; MicroVention, Inc...
October 28, 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/29054914/flow-diversion-for-the-treatment-of-posterior-inferior-cerebellar-artery-aneurysms-a-novel-classification-and-strategies
#15
Visish M Srinivasan, Michael George Zaki Ghali, Oleg E Reznik, Jacob Cherian, Maxim Mokin, Travis M Dumont, John R Gaughen, Ramesh Grandhi, Ajit S Puri, Stephen R Chen, Jeremiah N Johnson, Peter Kan
BACKGROUND: 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, treatment of posterior inferior cerebellar artery (PICA) aneurysms with flow diversion (FD) has not been specifically described or discussed. While there are reports of treating PICA aneurysms using placement of FD stents in the vertebral artery, there are no reports of treating these lesions by placement of flow diverting stents in the PICA vessel itself...
October 20, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29042328/ruptured-persistent-trigeminal-artery-causing-direct-cavernous-sinus-fistula-treated-with-pipeline-embolization-and-minimal-coiling
#16
Nam K Yoon, Al-Wala Awad, James M Gee, Philipp Taussky
BACKGROUND: Rupture of a persistent trigeminal artery associated with development of a cavernous sinus fistula in a traumatic setting is rare. They are typically treated with coil embolization of the cavernous sinus. CASE DESCRIPTION: We present the case of a 42-year-old woman who developed a direct cavernous carotid fistula after a motor-vehicle accident. Angiographic imaging revealed a rupture point of a persistent trigeminal artery as it connected with the cavernous segment of the internal carotid artery (ICA), causing a cavernous sinus fistula...
October 14, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28986614/clinical-and-angiographic-outcomes-in-patients-with-intracranial-aneurysms-treated-with-the-pipeline-embolization-device-intra-procedural-technical-difficulties-major-morbidity-and-neurological-mortality-decrease-significantly-with-increased-operator-experience
#17
Josser E Delgado Almandoz, Yasha Kayan, Andrea Tenreiro, Adam N Wallace, Jill M Scholz, Jennifer L Fease, Anna M Milner, Maximilian Mulder, Kyle M Uittenbogaard, Oscar Tenreiro-Picón
PURPOSE: Flow diversion constitutes a pivotal advancement in endovascular intracranial aneurysm treatment, but requires development of a new skill set. The aim of this study is to determine whether outcomes after treatment with the Pipeline Embolization Device improve with experience. METHODS: We retrospectively reviewed all patients with intracranial aneurysms treated with Pipeline at two centers over a 4.5-year period. Baseline patient and aneurysm characteristics, complications, and angiographic outcomes were analyzed...
December 2017: Neuroradiology
https://www.readbyqxmd.com/read/28961750/flow-diverting-stents-for-the-obliteration-of-symptomatic-infectious-cavernous-carotid-artery-aneurysms
#18
Andrew Joshua Kobets, Aleka Scoco, Jonathan Nakhla, Allan Leonard Brook, Merritt Drew Kinon, Nrupen Baxi, David Altschul
BACKGROUND: Intracavernous aneurysms constitute up to 9% of all intracranial aneurysms and 6% are infectious (IIA). First line therapy is a protracted antibiotic course, yet with failure, surgery and endovascular parent vessel sacrifice have been utilized. Reconstructive endovascular therapies have emerged for aneurysm control and may demonstrate a safer therapeutic alternative. OBJECTIVE: To present an IIA treated with a flow-diverting Pipeline stent (ev3 Neurovascular, Irvine, California)...
August 5, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28955510/usefulness-of-the-pipeline-embolic-device-for-large-and-giant-carotid-cavernous-aneurysms
#19
Shigeru Miyachi, Ryo Hiramatsu, Hiroyuki Ohnishi, Ryokichi Yagi, Toshihiko Kuroiwa
PURPOSE: Conventional coil embolization for large carotid cavernous aneurysms (CCAs) has limited utility due to its inability to prevent recurrences and reduce mass effect. Trapping of the parent artery may have a risk of ischemic complications due to intracranial perfusion disorders. We successfully treated 24 patients with large CCAs using a flow diverter (Pipeline™ embolic device: PED), and this report discusses the safety and efficacy of this method. MATERIALS AND METHODS: Twenty four patients (23 females, mean age 71...
September 2017: Neurointervention
https://www.readbyqxmd.com/read/28945879/morbidity-and-mortality-in-patients-with-posterior-circulation-aneurysms-treated-with-the-pipeline-embolization-device-a-subgroup-analysis-of-the-international-retrospective-study-of-the-pipeline-embolization-device
#20
Demetrius K Lopes, Dong-Kyu Jang, Saruhan Cekirge, David Fiorella, Ricardo A Hanel, David F Kallmes, Elad I Levy, Pedro Lylyk
BACKGROUND: The safety of PipelineTM Embolization Device (PED; Medtronic Inc, Dublin, Ireland) in posterior circulation aneurysms is still controversial. OBJECTIVE: To study complications associated with the treatment of posterior circulation aneurysms by conducting a subgroup analysis from the International Retrospective Study of PED registry. METHODS: Data from 91 consecutive patients with 95 posterior circulation aneurysms at 17 centers between July 2008 to February 2013 were analyzed...
September 18, 2017: Neurosurgery
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