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https://www.readbyqxmd.com/read/28565978/off-label-uses-of-the-pipeline-embolization-device-a-review-of-the-literature
#1
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
#2
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...
April 27, 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
#3
Paul Mazaris, Tapan Mehta, Mohammed Hussain, Violiza Inoa, Justin Singer, Gary Spiegel, Inam Kureshi, Martin Ollenschleger
INTRODUCTION: The purpose of our study is 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. 12 month angiographic and clinical follow-up was available for all patients...
April 17, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28402491/matched-comparison-of-flow-diversion-and-coiling-in-small-noncomplex-intracranial-aneurysms
#4
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...
April 10, 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
#5
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
#6
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...
March 6, 2017: 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
#7
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...
February 20, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27956518/use-of-self-expanding-stents-for-better-intracranial-flow-diverter-wall-apposition
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
https://www.readbyqxmd.com/read/26842611/histopathological-findings-following-pipeline-embolization-in-a-human-cerebral-aneurysm-at-the-basilar-tip
#14
Daying Dai, Yong-Hong Ding, Michael Kelly, Ramanathan Kadirvel, David Kallmes
We report histopathological findings from a human cerebral aneurysm following treatment with a flow diverter. A 75-year-old male underwent flow diversion treatment (Pipeline Embolization Device (PED)) and coil embolization for treatment of an aneurysm at the basilar tip. At four months, angiography showed complete aneurysm occlusion; at 12 months angiography demonstrated that the aneurysm had reopened. The patient expired from brainstem compression. The aneurysm cavity was primarily filled with unorganized thrombus...
April 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/26700827/safety-efficacy-and-short-term-follow-up-of-the-use-of-pipeline-embolization-device-in-small-2-5-mm-cerebral-vessels-for-aneurysm-treatment-single-institution-experience
#15
Ajit S Puri, Francesco Massari, Takumi Asai, Miklos Marosfoi, Peter Kan, Samuel Y Hou, Mary Howk, Mary Perras, Christopher Brooks, Frederic Clarencon, Matthew J Gounis, Ajay K Wakhloo
INTRODUCTION: Flow diversion is being increasingly used to treat cerebral aneurysms. We present our experience using these stents to treat aneurysms distal to the circle of Willis with parent arteries smaller than 2.5 mm. METHODS: Aneurysms treated with a Pipeline Embolization Device in vessels less than 2.5 mm between June 2012 and August 2014 were included. We evaluated risk factors, family history of aneurysms, aneurysm characteristics, National Institute of Health Stroke Scale (NIHSS), and modified Rankin scale (mRS) on admission and angiography and clinical outcome at discharge, 6 months, and 1 year...
March 2016: Neuroradiology
https://www.readbyqxmd.com/read/26628457/metal-coverage-ratio-of-pipeline-embolization-device-for-treatment-of-unruptured-aneurysms-reality-check
#16
Liang-Der Jou, Gouthami Chintalapani, Michel E Mawad
BACKGROUND AND PURPOSE: The metal coverage ratio (MCR) of a flow diverter influences the intra-aneurysmal hemodynamics; a high MCR will occlude an aneurysm early, while a low MCR may delay aneurysm occlusion. The true MCR of a pipeline embolization device (PED) could be lower due to oversize, device deformation, or aneurysm location. In this study deviation of the true MCR from the nominal MCR is assessed and whether their difference affects aneurysm occlusion rate is determined. METHODS: A total of 40 consecutive patients, each of them treated by one PED for their aneurysms at the internal carotid artery (ICA), were retrospectively analyzed...
February 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/26317674/fenestra-obscura-flow-diverter-reconstruction-of-a-complex-vertebrobasilar-aneurysm-through-an-obscured-fenestration-limb
#17
Gabor Toth, Ferdinand Hui, Mark Bain
BACKGROUND: Basilar fenestration aneurysms are rare, challenging intracranial vascular lesions with atypical anatomy. The posterior circulation represents a difficult therapeutic dilemma because of the close proximity of crucial life-sustaining brainstem structures. The use of flow diverter technology has been very limited in posterior circulation vessels. CLINICAL PRESENTATION: We present the case of a 49-year-old female patient, who was diagnosed with a symptomatic large vertebrobasilar junction aneurysm, which was initially thought to be a proximal basilar dilatation...
August 26, 2015: Neurosurgery
https://www.readbyqxmd.com/read/26159552/low-frequency-of-delayed-ischemic-events-on-mri-after-flow-diversion-for-intracranial-aneurysms
#18
S F Morales-Valero, W Brinjikji, J T Wald, G Lanzino
BACKGROUND AND PURPOSE: The rate of silent ischemia detected on MRI in the long-term follow-up period following endovascular treatment of intracranial aneurysms with the Pipeline Embolization Device (PED) is not well established. The purpose of this study was to evaluate the occurrence rate of silent ischemia detected on MRI in patients undergoing treatment of intracranial aneurysms with PED receiving at least 6 months of MRI follow-up. MATERIALS AND METHODS: We evaluated our institution's database of patients receiving PED treatment of intracranial aneurysms...
July 10, 2015: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/25964435/neurovascular-reconstruction-with-flow-diverter-stents-for-the-treatment-of-87-intracranial-aneurysms-clinical-results
#19
Leonardo Giacomini, Ronie L Piske, Carlos E Baccin, Marcelo Barroso, Andrei F Joaquim, Helder Tedeschi
BACKGROUND: Flow diverter stents represent a new endovascular tool to treat complex aneurysms, such as giant, large, wide-necked and fusiform. The highly dense mash of these stents reduces inflow and outflow inside the aneurysm, resulting in intra aneurysmal thrombosis and stent endothelialization. OBJECTIVES: To present the results of treatment of intracranial aneurysms with flow diverter stents in a single center. METHODS: Retrospective review of 77 patients with 87 aneurysms treated using two different types of flow diverter stent, the Pipeline Embolization Device and SILK stent, between October 2010 and September 2013 in an interventional neuroradiology center...
June 2015: Interventional Neuroradiology
https://www.readbyqxmd.com/read/25635478/safety-and-efficacy-of-the-pipeline-embolization-device-in-100-small-intracranial-aneurysms
#20
Nohra Chalouhi, Mario Zanaty, Alex Whiting, Steven Yang, Stavropoula Tjoumakaris, David Hasan, Robert M Starke, Shannon Hann, Christine Hammer, David Kung, Robert Rosenwasser, Pascal Jabbour
OBJECT Flow diverters are increasingly used for treatment of intracranial aneurysms. In most series, the Pipeline Embolization Device (PED) was used for the treatment of large, giant, complex, and fusiform aneurysms. Little is known about the use of the PED in small aneurysms. The purpose of this study was to assess the safety and efficacy of the PED in small aneurysms (≤ 7 mm). METHODS A total of 100 consecutive patients were treated with the PED at the authors' institution between May 2011 and September 2013...
June 2015: Journal of Neurosurgery
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