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Pipeline embolization device

Akil Patel, Timothy R Miller, Ravi Shivashankar, Gaurav Jindal, Dheeraj Gandhi
BACKGROUND AND OBJECTIVE: Acute thrombus formation following aneurysm treatment with the Pipeline embolization device (PED) is a potentially devastating complication that may result in significant thromboembolic sequelae if not promptly treated. We therefore evaluated PED cases complicated by acute thrombus formation at our institution, with an emphasis on identifying early angiographic signs that may portend this event. MATERIALS AND METHODS: We retrospectively identified cases of acute thrombosis following PED placement in 100 consecutive procedures performed at our institution from a prospectively maintained clinical database...
October 21, 2016: Journal of Neurointerventional Surgery
Tibor Becske, Matthew B Potts, Maksim Shapiro, David F Kallmes, Waleed Brinjikji, Isil Saatci, Cameron G McDougall, István Szikora, Giuseppe Lanzino, Christopher J Moran, Henry H Woo, Demetrius K Lopes, Aaron L Berez, Daniel J Cher, Adnan H Siddiqui, Elad I Levy, Felipe C Albuquerque, David J Fiorella, Zsolt Berentei, Miklós Marosföi, Saruhan H Cekirge, Peter K Nelson
OBJECTIVE The long-term effectiveness of endovascular treatment of large and giant wide-neck aneurysms using traditional endovascular techniques has been disappointing, with high recanalization and re-treatment rates. Flow diversion with the Pipeline Embolization Device (PED) has been recently used as a stand-alone therapy for complex aneurysms, showing significant improvement in effectiveness while demonstrating a similar safety profile to stent-supported coil treatment. However, relatively little is known about its long-term safety and effectiveness...
October 14, 2016: Journal of Neurosurgery
Sophia F Shakur, Victor A Aletich, Sepideh Amin-Hanjani, Ahmed E Hussein, Fady T Charbel, Ali Alaraj
BACKGROUND: Pipeline embolization devices (PEDs) are commonly used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral intraparenchymal hemorrhage. Although intra-aneurysmal hemodynamic changes have been studied, parent vessel and intracranial hemodynamics after PED use are unknown. We examine the impact of flow diversion on parent artery and distal intracranial hemodynamics. METHOD: Patients with internal carotid cerebral aneurysms treated with PED who had flow volume rate, flow velocities, pulsatility index, resistance index, Lindegaard ratio, and wall shear stress (WSS) obtained after treatment using quantitative magnetic resonance angiography were reviewed...
October 4, 2016: Interventional Neuroradiology
Jay Vachhani, Christopher Nickele, Lucas Elijovich, Paul Klimo, Adam S Arthur
Intracranial flow diversion has gained increasing popularity since the approval of the Pipeline Embolization Device (PED). Although it is only approved for use in adult patients, the PED has been used to treat aneurysms in pediatric patients. We present the first reported case of the use of a PED in a pediatric patient to treat an unusual fusiform distal anterior cerebral artery aneurysm. A 12-year-old female presented with new onset seizures and was found to have an incidental distal left anterior cerebral artery aneurysm...
September 29, 2016: World Neurosurgery
Albert Ho Yuen Chiu, Rajalakshmi Ramesh, Jason Wenderoth, Mark Davies, Andrew Cheung
Subarachnoid hemorrhage secondary to rupture of a circumferential dissecting aneurysm continues to be a treatment dilemma. Vessel sacrifice, when possible, continues to be the safest option but in certain cases this is not possible due to lack of collateral supply. In such cases, coil assisted endovascular flow diversion has become a potential option but the requirement for dual antiplatelet therapy in an unsecured intracranial aneurysm continues to raise concern.We present a 48-year-old man with a World Federation of Neurological Surgeons grade 5 subarachnoid hemorrhage, secondary to a ruptured intradural left vertebral artery dissecting aneurysm, who was treated successfully with a pipeline embolization device with Shield technology using aspirin and a single intravenous loading dose of abciximab...
September 28, 2016: Journal of Neurointerventional Surgery
Jung Soo Park, Hyo Sung Kwak, Jong Myong Lee
Use of the Pipeline embolization device (PED) has increased based on studies about its safety and effectiveness, and new reports that describe peri- or postprocedural complications are now emerging. We report a rare periprocedural device-related complication that occurred during endovascular treatment with the pipeline embolization device for a dissecting aneurysm on the vertebral artery. A 55-year old woman was admitted due to left medullary infarction, and angiography showed a fusiform dilatation in the left vertebral artery that was suspicious for dissecting aneurysm...
September 2016: Journal of Korean Neurosurgical Society
Pedro Aguilar-Salinas, Leonardo B C Brasiliense, Douglas Gonsales, Bartley Mitchell, Andrey Lima, Eric Sauvageau, Ricardo Hanel
Refinements in endovascular technology have revolutionized the treatment of intracranial aneurysms (IAs) with the development of flow-diversion technology. The first generation of the Pipelin Embolization Device (PED) has demonstrated its safety and efficacy. However, the deployment technique was a difficult task that often led to complex maneuvers. The Pipeline Flex Embolization Device (PED Flex) is the second generation and its introduction has arrived with high expectations due to a completely redesigned delivery system that intends to overcome deployment difficulties seen in the previous generation...
October 2016: Expert Review of Medical Devices
Raghav Gupta, Justin M Moore, Christoph J Griessenauer, Nimer Adeeb, Apar S Patel, Roy Youn, Karen Poliskey, Ajith J Thomas, Christopher S Ogilvy
INTRODUCTION: Flow diversion with the Pipeline Embolization Device (PED) is currently adopted for treatment of a variety of intracranial aneurysms. The elevated risk of thromboembolic complications associated with the device necessitates the need for administration of antiplatelet agents. We sought to assess current dual antiplatelet therapy practices patterns and their associated costs, following PED placement. MATERIALS AND METHODS: An online questionnaire assessing dual antiplatelet regimens following flow diversion for treatment of intracranial aneurysms was developed and disseminated to 80 neurosurgeons at major academic cerebrovascular centers...
September 15, 2016: World Neurosurgery
Peter Kan, Visish M Srinivasan, Nnenna Mbabuike, Rabih G Tawk, Vin Shen Ban, Babu G Welch, Maxim Mokin, Bartley D Mitchell, Ajit Puri, Mandy J Binning, Edward Duckworth
The Pipeline Embolization Device (PED) was approved for the treatment of intracranial aneurysms from the petrous to the superior hypophyseal segment of the internal carotid artery. However, since its approval, its use for treatment of intracranial aneurysms in other locations and non-sidewall aneurysms has grown tremendously. The authors report on a cohort of 15 patients with 16 cerebral aneurysms that incorporated an end vessel with no significant distal collaterals, which were treated with the PED. The cohort includes 7 posterior communicating artery aneurysms, 5 ophthalmic artery aneurysms, 1 superior cerebellar artery aneurysm, 1 anterior inferior cerebellar artery aneurysm, and 2 middle cerebral artery aneurysms...
September 16, 2016: Journal of Neurosurgery
David F Kallmes, Waleed Brinjikji, Edoardo Boccardi, Elisa Ciceri, Orlando Diaz, Rabih Tawk, Henry Woo, Pascal Jabbour, Felipe Albuquerque, Rene Chapot, Alain Bonafe, Shervin R Dashti, Josser E Delgado Almandoz, Curtis Given, Michael E Kelly, DeWitte T Cross, Gary Duckwiler, Nasser Razack, Ciaran J Powers, Sebastian Fischer, Demetrius Lopes, Mark R Harrigan, Daniel Huddle, Raymond Turner, Osama O Zaidat, Luc Defreyne, Vitor Mendes Pereira, Saruhan Cekirge, David Fiorella, Ricardo A Hanel, Pedro Lylyk, Cameron McDougall, Adnan Siddiqui, Istvan Szikora, Elad Levy
BACKGROUND AND OBJECTIVE: Few prospective studies exist evaluating the safety and efficacy of the Pipeline Embolization Device (PED) in the treatment of intracranial aneurysms. The Aneurysm Study of Pipeline In an observational Registry (ASPIRe) study prospectively analyzed rates of complete aneurysm occlusion and neurologic adverse events following PED treatment of intracranial aneurysms. MATERIALS AND METHODS: We performed a multicenter study prospectively evaluating patients with unruptured intracranial aneurysms treated with PED...
June 2016: Interventional Neurology
Matthew T Bender, Li-Mei Lin, Geoffrey P Colby, Daniel Lubelski, Judy Huang, Rafael J Tamargo, Alexander L Coon
INTRODUCTION: Recent reports suggest that thromboembolic complications are associated with Pipeline embolization device (PED) placement cluster in P2Y12 hyporesponders. OBJECTIVE: To evaluate the role of P2Y12 hyporesponse in PED placement by retrospectively reviewing a single-center series of patients. METHODS: We retrospectively reviewed an institutional review board-approved database of patients with an aneurysm at a single institution and identified all patients with a measured P2Y12 reaction unit (PRU)>200 who had undergone anterior circulation PED placement...
September 6, 2016: Journal of Neurointerventional Surgery
Anil K Roy, Jonathan A Grossberg, Joshua W Osbun, Susana L Skukalek, Brian M Howard, Faiz U Ahmad, Frank Tong, Jacques E Dion, Charles M Cawley
OBJECTIVE: Carotid cavernous fistula (CCF) development after Pipeline Embolization Device (PED) treatment of cavernous carotid aneurysms (CCA) can be a challenging pathology to treat for the neurointerventionalist. METHODS: A database of all patients whose aneurysms were treated with the PED since its approval by the Food and Drug Administration in 2011 was retrospectively reviewed. Demographic information, aneurysm characteristics, treatment technique, antiplatelet regimen, and follow-up data were collected...
September 5, 2016: Journal of Neurointerventional Surgery
Mario Zanaty, Badih Daou, Nohra Chalouhi, Robert M Starke, Edgar Samaniego, Colin Derdeyn, Pascal Jabbour, David Hasan
OBJECTIVE: The Pipeline Embolization Device has been used shown safe under Monitored Anesthesia Care (MAC). We present the results of the first study assessing the safety and feasibility of same-day discharge in patients undergoing treatment with the PED, using MAC. METHODS: A total of 130 patients with 143 CAs were identified. Patients were treated under MAC with PED. All patients were counseled pre-operatively about the elective nature of the procedure and the same-day discharge...
August 23, 2016: World Neurosurgery
Nimer Adeeb, Christoph J Griessenauer, Apar S Patel, Justin Moore, Parviz Dolati-Ardejani, Raghav Gupta, Rouzbeh Motiei-Langroudi, Christopher S Ogilvy, Ajith J Thomas
INTRODUCTION: Single-volume reconstruction of three-dimensional (3D) digital subtraction angiography (DSA) can be effectively used for aneurysm assessment and planning of endovascular embolization. Unfortunately, post-embolization follow-up angiographic images can be obscured by artifact. The dual-volume reconstruction technique was developed in order to reduce artifact and enhance the visualization of the aneurysm, the parent vessel and side branches, and endovascular devices. The purpose of this study was to compare the reliability of dual- vs single-volume reconstruction of 3D DSA in evaluation of follow-up images after endovascular embolization of intracranial aneurysms...
August 16, 2016: Interventional Neuroradiology
Christoph J Griessenauer, Christopher S Ogilvy, Paul M Foreman, Michelle H Chua, Mark R Harrigan, Lucy He, Matthew R Fusco, J D Mocco, Christopher J Stapleton, Aman B Patel, Ashish Sonig, Adnan H Siddiqui, Ajith J Thomas
BACKGROUND: To date, the use of the flow-diverting Pipeline Embolization Device (PED) for small intracranial aneurysms (≤ 7 mm) has been reported only in single-center series. OBJECTIVE: To evaluate the safety and efficacy of the PED in a multicenter cohort. METHODS: Five major academic institutions in the United States provided data on patient demographics, aneurysm features, and treatment characteristics of consecutive patients with aneurysms ≤ 7 mm treated with a PED between 2009 and 2015...
August 1, 2016: Neurosurgery
Stefan Thomas Lang, Zarina Assis, John H Wong, William Morrish, Alim P Mitha
A 62-year-old woman presented with a subarachnoid hemorrhage secondary to a ruptured right supraclinoid internal carotid artery blister aneurysm. She was treated in an emergent fashion with two flow diverting pipeline embolization devices (PED) deployed in a telescoping fashion. CT angiography performed for unrelated reasons at 7 months showed successful treatment of the aneurysm without evidence of residual aneurysm. However, a follow-up digital subtraction angiogram performed at 9 months showed a large aneurysm in a modified position compared with the original aneurysm...
July 28, 2016: Journal of Neurointerventional Surgery
Christoph J Griessenauer, Raghav Gupta, Justin Moore, Ajith J Thomas, Christopher S Ogilvy
BACKGROUND: Distal landing zone accuracy is critical in some intracranial aneurysms treated with the Pipeline Embolization Device (PED), and delayed opening of the distal end of the device can complicate the procedure. Here, we report a technical nuance that facilitates accurate placement of the distal end of the PED by ex-vivo, pre-implantation release of the PED Flex polytetrafluoroethylene (PTFE) sleeves. TECHNICAL NOTE: The PED Flex is partially pushed out of the introducer sheath ex-vivo, pre-implantation until the distal PED opens entirely and the PTFE sleeves are located distal to the device...
July 28, 2016: Interventional Neuroradiology
Stefan Thomas Lang, Zarina Assis, John H Wong, William Morrish, Alim P Mitha
A 62-year-old woman presented with a subarachnoid hemorrhage secondary to a ruptured right supraclinoid internal carotid artery blister aneurysm. She was treated in an emergent fashion with two flow diverting pipeline embolization devices (PED) deployed in a telescoping fashion. CT angiography performed for unrelated reasons at 7 months showed successful treatment of the aneurysm without evidence of residual aneurysm. However, a follow-up digital subtraction angiogram performed at 9 months showed a large aneurysm in a modified position compared with the original aneurysm...
2016: BMJ Case Reports
Loyola V Gressot, Akash J Patel, Visish M Srinivasan, Adam Arthur, Peter Kan, Edward A M Duckworth
BACKGROUND: The pipeline embolization device (PED) is a flow-diverting stent that provides an additional treatment modality in the management of intracranial aneurysms. An aneurysm treated with a flow diverter is expected to involute over time, contrary to the immediate obliteration expected by surgical clipping or coiling. Yet, which aneurysms will respond to PED therapy and the time frame to expect full obliteration remain unclear. CASE DESCRIPTION: We report the unusual case of a 50-year-old woman with multiple (4 total) intracranial aneurysms who underwent multimodality treatment...
September 2016: World Neurosurgery
Raghav Gupta, Christoph Johannes Griessenauer, Nimer Adeeb, Justin M Moore, Apar S Patel, Michelle Hui Juan Chua, Ajith J Thomas, Christopher S Ogilvy
INTRODUCTION: Unruptured intracranial aneurysms (UIAs) are being detected at a greater rate. Advances in endovascular technologies have reduced procedural morbidity and mortality compared with traditional surgical clipping in a subset of these cases. Little exists in the literature identifying optimal follow-up imaging protocols for these patients. Given recent data that suggest that percent occlusion of the aneurysm at follow-up correlates strongly with the rate of rerupture, the utilization of imaging modalities that are both specific and sensitive for aneurysm detection, at the appropriate time points, is essential...
August 2016: Neurosurgery
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