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https://www.readbyqxmd.com/read/29584923/rescue-therapy-for-procedural-complications-associated-with-deployment-of-flow-diverting-devices-in-cerebral-aneurysms
#1
Fawaz Al-Mufti, Krishna Amuluru, Eric R Cohen, Vikas Patel, Mohammad El-Ghanem, Ethan Wajswol, Vincent Dodson, Sarmad Al-Marsoummi, Neil Majmundar, Neha S Dangayach, Rolla Nuoman, Chirag D Gandhi
Flow diverting devices (FDDs) have revolutionized the treatment of morphologically complex intracranial aneurysms such as wide-necked, giant, or fusiform aneurysms. Although FDDs are extremely effective, they carry a small yet significant risk of intraprocedural complications. As the implementation of these devices increases, the ability to predict and rapidly treat complications, especially those that are iatrogenic or intraprocedural in nature, is becoming increasingly more necessary.Our objective in this paper is to provide a descriptive summary of the various types of intraprocedural complications that may occur during FDDs deployment and how they may best be treated...
March 22, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29457589/short-term-efficacy-of-pipeline-embolization-device-for-treating-complex-intracranial-aneurysms
#2
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
https://www.readbyqxmd.com/read/29354333/transvenous-aneurysm-sac-and-rupture-point-coil-embolization-of-direct-carotid-cavernous-fistula-after-pipeline-embolization
#3
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
https://www.readbyqxmd.com/read/29279045/ticagrelor-for-neuroendovascular-procedures-a-case-series
#4
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...
February 2018: Journal of Pharmacy Practice
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/29089414/flow-diversion-for-anterior-choroidal-artery-acha-aneurysms-a-multi-institutional-experience
#6
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/28844913/analysis-of-predictors-and-probability-of-aneurysm-occlusion-in-the-internal-carotid-artery-after-treatment-with-pipeline-embolization-device
#7
Leonardo B C Brasiliense, Pedro Aguilar-Salinas, David A Miller, Rabih G Tawk, Eric A Sauvageau, Ricardo A Hanel
BACKGROUND: Although the Pipeline Embolization Device (PED) has proved to be an excellent option for internal carotid artery (ICA) aneurysms, the rate of occlusion remains difficult to predict and factors associated with aneurysm occlusion are not well elucidated. This study aimed to investigate predictors and the rate of occlusion for aneurysms along the ICA. METHODS: A total of 117 saccular ICA aneurysms treated with the PED were studied. Occlusion rates were divided among 4 groups: group A [lesions >10 mm in the proximal ICA (petrous to the superior hypophyseal segments)]; group B (lesions <10 mm in the proximal ICA); group C [lesions >10mm in the distal ICA (posterior communicating segment to the ICA bifurcation)]; and group D (lesions <10 mm in the distal ICA)...
November 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28565978/off-label-uses-of-the-pipeline-embolization-device-a-review-of-the-literature
#8
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
https://www.readbyqxmd.com/read/28457861/comparison-of-3d-tof-mr-angiographic-accuracy-in-predicting-raymond-grade-of-flow-diverted-versus-coiled-intracranial-aneurysms
#9
Tamar R Binyamin, Brian C Dahlin, Ben Waldau
The accuracy of 3D time of Flight Magnetic Resonance Angiography (TOF MRA) has been studied extensively for following coiled intracranial aneurysms. It is used by many clinicians for non-invasive follow-up because of its adequate sensitivity in predicting aneurysmal recanalization compared to diagnostic cerebral angiography. The data on the accuracy of 3D TOF MRA for the Pipeline™ Embolization Device (PED) are sparse. In a retrospective chart review, we compared the accuracy of 3D TOF MRA of PED to coil embolization at our institution...
August 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28427972/endovascular-treatment-of-complex-distal-posterior-cerebral-artery-aneurysms-with-the-pipeline-embolization-device
#10
Paul Mazaris, Tapan Mehta, Mohammed Hussain, Violiza Inoa, Justin Singer, Gary Spiegel, Inam Kureshi, Martin Ollenschleger
OBJECTIVE: To assess the safety and efficacy of the Pipeline Embolization Device (PED) for endovascular treatment of complex, distal posterior cerebral artery (PCA) aneurysms. METHODS: We conducted a retrospective review of patients who underwent endovascular treatment of complex PCA aneurysms with PED from November 2012 to December 2015. A total of 4 patients were identified and treated. Twelve-month angiographic and clinical follow-up was available for all patients...
November 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28402491/matched-comparison-of-flow-diversion-and-coiling-in-small-noncomplex-intracranial-aneurysms
#11
Nohra Chalouhi, Badih Daou, Guilherme Barros, Robert M Starke, Ameet Chitale, George Ghobrial, Richard Dalyai, David Hasan, L Fernando Gonzalez, Stavropoula Tjoumakaris, Robert H Rosenwasser, Pascal Jabbour
BACKGROUND: Flow diversion is typically reserved for large, giant, or morphologically complex aneurysms. Coiling remains a first-line treatment for small, morphologically simple aneurysms. OBJECTIVE: To compare coiling and flow diversion in small, uncomplicated intracranial aneurysms (typically amenable to coiling). METHODS: Forty patients treated with the pipeline embolization device (PED) for small (<10 mm), morphologically simple aneurysms that would have also been amenable to coiling were identified...
July 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28362932/commentary-pipeline-embolization-device-for-small-intracranial-aneurysms-evaluation-of-safety-and-efficacy-in-a-multicenter-cohort
#12
Charles J Prestigiacomo
No abstract text is available yet for this article.
April 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28265011/tourniquet-parent-artery-occlusion-after-flow-diversion
#13
Visish M Srinivasan, Maxim Mokin, Edward A M Duckworth, Stephen Chen, Ajit Puri, Peter Kan
BACKGROUND: The Pipeline Embolization Device (PED) is increasingly used for both on- and off-label purposes for treatment of intracranial aneurysms. The device gradually slows flow of blood into the aneurysm, but the high metal coverage of PED promotes endothelialization of the device. Occasionally, this leads to in-stent stenosis that is clinically well tolerated. We present a multi-institutional Pipeline series that includes three cases of gradual asymptomatic occlusion within the PED and parent vessel...
February 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28223428/periprocedural-outcomes-and-early-safety-with-the-use-of-the-pipeline-flex-embolization-device-with-shield-technology-for-unruptured-intracranial-aneurysms-preliminary-results-from-a-prospective-clinical-study
#14
Mario Martínez-Galdámez, Saleh M Lamin, Konstantinos G Lagios, Thomas Liebig, Elisa F Ciceri, Rene Chapot, Luc Stockx, Swarupsinh Chavda, Christoph Kabbasch, Giuseppe Farago, Hannes Nordmeyer, Thierry Boulanger, Mariangela Piano, Edoardo P Boccardi
BACKGROUND AND PURPOSE: The Pipeline Embolization Device (PED) has become a routine first-line option for treatment of intracranial aneurysms (IAs). We assessed the early safety and technical success of a new version of PED, Pipeline Flex Embolization Device with Shield Technology (Pipeline Shield), which has the same design and configuration but has been modified to include a surface synthetic biocompatible polymer. MATERIALS AND METHODS: The Pipeline Flex Embolization Device with Shield Technology (PFLEX) study is a prospective, single-arm, multicenter study for the treatment of unruptured IAs using Pipeline Shield...
August 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27956518/use-of-self-expanding-stents-for-better-intracranial-flow-diverter-wall-apposition
#15
Anna Luisa Kühn, Ajay K Wakhloo, Matthew J Gounis, Peter Kan, Katyucia de Macedo Rodrigues, J Diego Lozano, Miklos G Marosfoi, Mary Perras, Christopher Brooks, Mary C Howk, David E Rex, Francesco Massari, Ajit S Puri
Background Flow diverter (FD) malapposition is associated with stroke-related complications. We document the use of self-expanding nitinol stents to remove/reduce the ledge of a FD deployed for aneurysm treatment. Methods We identified five patients who were treated with the Pipeline embolization device (PED) in conjunction with a Neuroform EZ stent for inadequate wall apposition of the ends of the FD at our institution between May 2014 and July 2015. Among other parameters, angiographic results, cone-beam computed tomography assessment of wall apposition and patient clinical outcome were evaluated...
April 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27651873/inadvertent-complication-of-a-pipeline-embolization-device-for-treatment-with-vertebral-artery-dissecting-aneurysm-distal-tip-fracture-of-delivery-wire
#16
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
https://www.readbyqxmd.com/read/27489165/pipeline-embolization-device-for-small-intracranial-aneurysms-evaluation-of-safety-and-efficacy-in-a-multicenter-cohort
#17
MULTICENTER STUDY
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...
April 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/27341046/stent-deployment-protocol-for-optimized-real-time-visualization-during-endovascular-neurosurgery
#18
Michael A Silva, Alfred P See, Hormuzdiyar H Dasenbrock, Ramsey Ashour, Priyank Khandelwal, Nirav J Patel, Kai U Frerichs, Mohammad A Aziz-Sultan
Successful application of endovascular neurosurgery depends on high-quality imaging to define the pathology and the devices as they are being deployed. This is especially challenging in the treatment of complex cases, particularly in proximity to the skull base or in patients who have undergone prior endovascular treatment. The authors sought to optimize real-time image guidance using a simple algorithm that can be applied to any existing fluoroscopy system. Exposure management (exposure level, pulse management) and image post-processing parameters (edge enhancement) were modified from traditional fluoroscopy to improve visualization of device position and material density during deployment...
May 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27075485/flow-diversion-with-pipeline-embolic-device-as-treatment-of-subarachnoid-hemorrhage-secondary-to-blister-aneurysms-dual-center-experience-and-review-of-the-literature
#19
REVIEW
Italo Linfante, Michael Mayich, Ashish Sonig, Jena Fujimoto, Adnan Siddiqui, Guilherme Dabus
BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) secondary to blister-type aneurysms (BAs) is associated with high morbidity and mortality. Microsurgical clipping or wrapping and/or use of traditional endovascular techniques to repair the lesion result in frequent regrowth and rebleeds and ultimately high fatality rates. Because of the purely endoluminal nature of arterial reconstruction, flow diversion may represent an ideal option to repair ruptured BAs. METHODS: We performed a retrospective analysis of our database including all consecutive patients with aSAH secondary to BAs treated with the Pipeline Embolic Device (PED) between November 2013 and November 2015 in two institutions...
January 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/26943842/pipeline-embolization-device-for-small-paraophthalmic-artery-aneurysms-with-an-emphasis-on-the-anatomical-relationship-of-ophthalmic-artery-origin-and-aneurysm
#20
Christoph J Griessenauer, Christopher S Ogilvy, Paul M Foreman, Michelle H Chua, Mark R Harrigan, Christopher J Stapleton, Aman B Patel, Lucy He, Matthew R Fusco, J Mocco, Peter A Winkler, Apar S Patel, Ajith J Thomas
OBJECTIVE Contemporary treatment for paraophthalmic artery aneurysms includes flow diversion utilizing the Pipeline Embolization Device (PED). Little is known, however, about the potential implications of the anatomical relationship of the ophthalmic artery (OA) origin and aneurysm, especially in smaller aneurysms. METHODS Four major academic institutions in the United States provided data on small paraophthalmic aneurysms (≤ 7 mm) that were treated with PED between 2009 and 2015. The anatomical relationship of OA origin and aneurysm, radiographic outcomes of aneurysm occlusion, and patency of the OA were assessed using digital subtraction angiography...
December 2016: Journal of Neurosurgery
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