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pipeline AND small aneurysm

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...
December 12, 2016: Interventional Neuroradiology
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
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
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...
June 24, 2016: Journal of Neurosurgery
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
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
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
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
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
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
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
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
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
Francesco Briganti, Luigi Delehaye, Giuseppe Leone, Carmine Sicignano, Giuseppe Buono, Mariano Marseglia, Ferdinando Caranci, Fabio Tortora, Francesco Maiuri
PURPOSE: Experience with the endovascular treatment of middle cerebral artery (MCA) aneurysms by flow diverter devices (FDD) is still limited. This study examines the results and complications of FDD for small aneurysms at this location. METHODS: From February 2010 to December 2013, 14 patients (10 women; mean age 59 years) with 15 small MCA aneurysms were treated with FDD. All procedures were performed with the Pipeline embolization device (PED). RESULTS: Complete occlusion was obtained in 12/15 aneurysms (80%) and partial occlusion in 3 (20%)...
March 2016: Journal of Neurointerventional Surgery
A R Martin, J P Cruz, C O'Kelly, M Kelly, J Spears, T R Marotta
Flow diversion has become an established treatment option for challenging intracranial aneurysms. The use of small devices of ≤3-mm diameter remains unapproved by major regulatory bodies. A retrospective review of patients treated with Pipeline Embolization Devices of ≤3-mm diameter at 3 Canadian institutions was conducted. Clinical and radiologic follow-up data were collected and reported. Twelve cases were treated with ≥1 Pipeline Embolization Device of ≤3-mm diameter, including 2 with adjunctive coiling, with a median follow-up of 18 months (range, 4-42 months)...
March 2015: AJNR. American Journal of Neuroradiology
D F Kallmes, R Hanel, D Lopes, E Boccardi, A Bonafé, S Cekirge, D Fiorella, P Jabbour, E Levy, C McDougall, A Siddiqui, I Szikora, H Woo, F Albuquerque, H Bozorgchami, S R Dashti, J E Delgado Almandoz, M E Kelly, R Turner, B K Woodward, W Brinjikji, G Lanzino, P Lylyk
BACKGROUND AND PURPOSE: Flow diverters are increasingly used in the endovascular treatment of intracranial aneurysms. Our aim was to determine neurologic complication rates following Pipeline Embolization Device placement for intracranial aneurysm treatment in a real-world setting. MATERIALS AND METHODS: We retrospectively evaluated all patients with intracranial aneurysms treated with the Pipeline Embolization Device between July 2008 and February 2013 in 17 centers worldwide...
January 2015: AJNR. American Journal of Neuroradiology
W Brinjikji, D F Kallmes, H J Cloft, G Lanzino
BACKGROUND AND PURPOSE: Treatment of cerebral aneurysms with flow diverters often mandates placement of the device across the ostia of major branches of the internal carotid artery. We determined the patency rates of the anterior choroidal artery after placement of flow-diversion devices across its ostium. MATERIALS AND METHODS: We analyzed a consecutive series of patients in whom a Pipeline Embolization Device was placed across the ostium of an angiographically visible anterior choroidal artery while treating the target aneurysm...
March 2015: AJNR. American Journal of Neuroradiology
Fatih Keskin, Fatih Erdi, Bülent Kaya, Necdet Poyraz, Suat Keskin, Erdal Kalkan, Orhan Ozbek, Osman Koc
OBJECTIVE: Endovascular coil embolization has become an effective treatment modality for most intracranial aneurysms. However, complex aneurysms including large and giant aneurysms, fusiform shaped aneurysms, wide necked aneurysm, or small aneurysm that are unsuitable for coil embolization are still deterrent to be treated. Flow diversion is a novel concept that is applied in the treatment of these complex intracranial aneurysms. METHOD: We review the results and important features of 25 aneurysms in 24 patients who underwent endovascular treatment by using the pipeline flow-diverter embolization device...
April 2015: Neurological Research
Karam Moon, Felipe C Albuquerque, Andrew F Ducruet, R Webster Crowley, Cameron G McDougall
OBJECT: Intracranial aneurysms, especially those of the cavernous segment of the internal carotid artery (ICA), can present with cranial nerve (CN) palsies. The Pipeline Embolization Device (PED) has demonstrated safety and efficacy in the treatment of cerebral aneurysms by flow diversion, but little data exist reporting the outcomes of cranial neuropathies following treatment with the device. METHODS: The prospectively maintained Barrow Neurological Institute's endovascular database was reviewed for all patients treated with the PED after presenting with one or more CN palsies secondary to a cerebral aneurysm since May 2011...
November 2014: Journal of Neurosurgery
Mario Zanaty, Nohra Chalouhi, Robert M Starke, Guilherme Barros, Mark Philip Saigh, Eric Winthrop Schwartz, Norman Ajiboye, Stavropoula I Tjoumakaris, David Hasan, Robert H Rosenwasser, Pascal Jabbour
BACKGROUND AND PURPOSE: Several endovascular treatment options are available for cavernous carotid aneurysms. We compared pipeline embolization device (PED) versus conventional endovascular treatment in terms of evolution of mass effect, complications, recurrence, and retreatment rate. METHODS: One hundred fifty-seven patients harboring 167 cavernous carotid aneurysms were treated using PED placement, coiling, stent-assisted coiling, and carotid vessel destruction...
September 2014: Stroke; a Journal of Cerebral Circulation
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