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Pipeline embolic device

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OBJECTIVEDual antiplatelet therapy is required for the treatment of intracranial aneurysms with the Pipeline embolization device (PED). Platelet function testing (PFT) is often used to assess the efficacy of the antiplatelet regimen prior to PED placement. The optimal impedance values for whole blood aggregometry in this setting have not been defined.METHODSA retrospective review of a prospectively maintained database was performed for the years 2011-2015 to identify patients with intracranial aneurysms treated with the PED who underwent pretreatment PFT using whole blood aggregometry...
November 1, 2018: Journal of Neurosurgery
Adam N Wallace, Josser E Delgado Almandoz, Yasha Kayan, Jennifer L Fease, Jill M Scholz, Anna M Milner, Mary Thomas
BACKGROUND: The Pipeline Embolization Device (PED) has expanded the range of aneurysms amenable to endovascular treatment, including some that were previously untreatable. The PED contains several metals, including nickel, cobalt, chromium, platinum and tungsten. The safety of implanting the PED in patients with cutaneous metal allergy is unknown. The purpose of this study was to assess the clinical and angiographic outcomes of PED treatment in patients with nickel allergy. METHODS: A single-institution neurointerventional database was retrospectively reviewed for patients with a documented cutaneous metal allergy treated with the PED...
November 23, 2018: World Neurosurgery
Amit Pujari, Brian Matthew Howard, Thomas P Madaelil, Susana Libhaber Skukalek, Anil K Roy, Jacques E Dion, C Michael Cawley, Jonathan A Grossberg
BACKGROUND: The pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied. METHODS: We conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded...
November 24, 2018: Journal of Neurointerventional Surgery
Randall G Krug, Alice Y Chang, Aditya Raghunathan, Jamie J Van Gompel
BACKGROUND: Crooke's cell adenomas (CCAs) are rare and potentially aggressive pituitary tumors that often invade the cavernous sinuses. Although clinical presentations of pituitary tumors may include the development of accompanying intracranial aneurysms, there are no documented cases of coexistent intracranial aneurysms and CCAs to date. Herein we describe an apoplectic silent CCA that presented with adjacent cavernous internal carotid artery (ICA) aneurysms. CASE DESCRIPTION: A 45-year old male patient presented for evaluation of headaches and diplopia...
November 19, 2018: World Neurosurgery
A Sweid, E Atallah, N Herial, H Saad, N Mouchtouris, G Barros, M R Gooch, S Tjoumakaris, H Zarzour, D Hasan, N Chalouhi, R H Rosenwasser, P Jabbour
BACKGROUND AND PURPOSE: Flow-diversion therapy (FDT) for large and complex intracranial aneurysms is effective and considered superior to primary coil embolization. Data evaluating common treatment with both FDT and coiling continues to emerge, but information on outcomes remains scarce. This study aims to examine further the efficiency and outcomes correlated with joint FDT using pipeline embolization device (PED) and coiling compared to PED-alone in treating intracranial aneurysms. MATERIALS AND METHODS: Comparative review and analysis of aneurysm treatment with PED in 416 subjects were conducted...
December 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
M Shapiro, A Shapiro, E Raz, T Becske, H Riina, P K Nelson
BACKGROUND AND PURPOSE: Flow diversion is being increasingly used to treat bifurcation aneurysms. Empiric approaches have generally led to encouraging results, and a growing body of animal and ex vivo literature addresses the fate of target aneurysms and covered branches. Our prior investigations highlighted the dynamic nature of metal coverage provided by the Pipeline Embolization Device and suggested strategies for creating optimal single and multidevice constructs. We now address the geometric and hemodynamic aspects of jailing branch vessels and neighboring target aneurysms...
November 15, 2018: AJNR. American Journal of Neuroradiology
Matthew T Bender, Chau D Vo, Bowen Jiang, Jessica K Campos, David A Zarrin, Risheng Xu, Erick M Westbroek, Justin M Caplan, Judy Huang, Rafael J Tamargo, Li-Mei Lin, Geoffrey P Colby, Alexander L Coon
Introduction: This study assessed the safety and effectiveness of the Pipeline embolization device (PED) for persistent and recurrent aneurysms previously treated with either a vascular reconstruction device (VRD) or a flow diverter (FD). Methods: A prospective, IRB-approved database was analyzed for patients treated with PED for aneurysms previously treated with a stent. Results: Twenty procedures were performed on 18 patients, 11 with prior FD, 7 with VRD, and 2 previously treated with both...
October 2018: Interventional Neurology
Mario Martínez-Galdámez, Jorge Escartín, Boris Pabón, Carlos Diaz, Roberto Martín-Reyes, Antonio Hermosín, Eduardo Crespo, Claudio Rodríguez, Gonzalo Monedero, Krishna Joshi, Demetrius K Lopes
BACKGROUND: The new generation of flow diverters includes a surface modification with a synthetic biocompatible polymer, which makes the device more biocompatible and less thrombogenic. Optical coherence tomography (OCT) can be used to visualize perforators, stent wall apposition, and intra-stent thrombus. Unfortunately real world application of this technology has been limited because of the limited navigability of these devices in the intracranial vessels. In this report, we share our experience of using 3D-printed neurovascular anatomy models to simulate and test the navigability of a commercially available OCT system and to show the application of this device in a patient treated with the new generation of surface modified flow diverters...
November 5, 2018: Interventional Neuroradiology
T R Miller, M J Kole, E J Le, G Cannarsa, S Jones, A P Wessell, G Jindal, E F Aldrich, J M Simard, D Gandhi
BACKGROUND AND PURPOSE: Although covered side branches typically remain patent acutely following Pipeline Embolization Device embolization of intracranial aneurysms, the long-term fate of these vessels remains uncertain. We therefore elected to investigate factors that may influence the long-term patency of these covered side branches. MATERIALS AND METHODS: We retrospectively evaluated the long-term patency of side branches covered by the Pipeline Embolization Device at our institution during treatment of intracranial aneurysms with at least 6 months of conventional angiography follow-up...
November 1, 2018: AJNR. American Journal of Neuroradiology
Hidenori Oishi, Kosuke Teranishi, Kenji Yatomi, Takashi Fujii, Munetaka Yamamoto, Hajime Arai
Flow diverters (FDs) have been developed for intracranial aneurysms difficult to treat with conventional endovascular therapy and surgical clipping. We reviewed 94 patients with 100 large or giant unruptured internal carotid artery (ICA) aneurysms treated with Pipeline embolization device (PED) embolization from December 2012 to June 2017 at Juntendo University Hospital. The patients' mean age was 63.4 years (range, 19-88), and there were 90 women 89.4%. Aneurysm locations were: C4 (45), C3 (4), and C2 (51) in ICA segments...
November 15, 2018: Neurologia Medico-chirurgica
Vijay M Ravindra, Julius Griauzde, Jonathan P Scoville, Craig J Kilburg, D Andrew Wilkinson, Clint Christensen, William T Couldwell, Philipp Taussky
OBJECTIVE: Flow diversion has been an important addition to endovascular neurosurgery, but its use in the posterior circulation remains controversial. Our goal is to describe the safety and efficacy of moderate sedation during flow diversion for posterior circulation lesions (aneurysms or dissecting pseudoaneurysms). METHODS: The authors retrospectively reviewed the medical records of all patients who underwent placement of a Pipeline embolization device for a posterior circulation lesion from August 2012 through November 2017...
September 28, 2018: World Neurosurgery
Gonca Eldem, Erhan Erdoğan, Bora Peynircioğlu, Anıl Arat, Ferhun Balkancı
PURPOSE: We aimed to report a single center's experience on endovascular treatment of true renal artery aneurysms (TRAAs), including treatment techniques and outcomes. METHODS: This retrospective study was designed to evaluate the treatment and follow-up of TRAAs treated by a variety of endovascular interventional techniques over a period of 6 years. Six patients with nine TRAAs were identified; seven of the TRAAs were treated using different combinations of coil embolization and flow diverter stents...
September 28, 2018: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Mario Martínez-Galdámez, Saleh M Lamin, Konstantinos G Lagios, Thomas Liebig, Elisa F Ciceri, Rene Chapot, Luc Stockx, Swarupsinh Chavda, Christoph Kabbasch, Giuseppe Faragò, Hannes Nordmeyer, Thierry Boulanger, Mariangela Piano, Edoardo P Boccardi
PURPOSE: The Pipeline Embolization Device (PED) is a routine first-line treatment option for intracranial aneurysms (IAs). The Pipeline Flex Embolization Device with Shield Technology (Pipeline Shield) is an updated version of the PED which has been modified to include a surface phosphorylcholine biocompatible polymer. Its early technical success and safety have been reported previously. Here, we assessed the long-term safety and efficacy of the Pipeline Shield for the treatment of IAs...
September 27, 2018: Journal of Neurointerventional Surgery
Boris Pabón Guerrero, Carlos Díaz Pacheco, Ahmed Saied, Krishna Joshi, Claudio Rodríguez, Mario Martínez-Galdámez, Demetrius K Lopes
A 64-year-old female presented with an incidentally-discovered right posterior inferior cerebral artery (PICA) aneurysm, initially treated in 2015 by simple coiling. Follow-up demonstrated significant coil compaction that required retreatment. Retreatment was done uneventfully using a Pipeline embolization device (PED) shield deployed starting from the basilar artery and ending at the V4 segment of the vertebral artery. Eight-weeks post-deployment, a follow-up digital subtraction imaging (DSA) and intravascular imaging with optical coherence tomography were obtained...
September 2018: Neurointervention
Matthew T Bender, David A Zarrin, Jessica K Campos, Bowen Jiang, Arun Chandra, Chau D Vo, Justin M Caplan, Judy Huang, Rafael J Tamargo, Li-Mei Lin, Geoffrey P Colby, Alexander L Coon
Background: Dual antiplatelet therapy (DAT), most commonly with aspirin and Clopidogrel, is the standard of care for intracranial stenting, including flow diversion. Clopidogrel response varies by individual. Objective: To investigate the real-world precision of VerifyNow P2Y12 assessment (Accumetrics, San Diego, California) of Clopidogrel response. Methods: Using a prospectively-collected, IRB-approved cerebral aneurysm database 643 patients were identified who were treated with the Pipeline embolization device from 2011 to 2017...
August 29, 2018: Neurosurgery
Mohamed M Salem, Georgios A Maragkos, Alejandro Enriquez-Marulanda, Luis Ascanio, Krishnan Ravindran, Abdulrahman Y Alturki, Christopher S Ogilvy, Ajith J Thomas, Justin M Moore
BACKGROUND: The effect of statins and diabetes on angiographic and clinical outcomes in aneurysms treated with pipelines has not been adequately reported. Our aim is to assess the effect of concurrent statin medications and diabetes mellitus (DM) on aneurysm occlusion status and outcomes in patients treated with the pipeline embolization device. METHODS: A retrospective review of our institution's database of aneurysms treated with the pipeline embolization device between 2013 and 2017 was conducted...
December 2018: World Neurosurgery
Yupeng Zhang, Chao Ma, Shikai Liang, Peng Yan, Fei Liang, Feng Guo, Chuhan Jiang
OBJECTIVE: To explore whether computed morphologic features can be used as independent predictors of incomplete occlusion of aneurysms treated with the Pipeline embolization device. METHODS: From January 2016 to September 2017, 58 patients with 58 aneurysms were treated with the Pipeline embolization device. Aneurysms were manually segmented from the Digital Imaging and Communications in Medicine file, and we calculated 16 shape features voxel by voxel on the segmented aneurysm image...
November 2018: World Neurosurgery
Anna Luisa Kühn, Peter Kan, Visish Srinivasan, David E Rex, Katyucia de Macedo Rodrigues, Mary C Howk, Ajay K Wakhloo, Ajit S Puri
Background To evaluate the feasibility and efficacy of the pipeline embolization device in the treatment of unruptured intracranial mirror segment aneurysms. Methods Out of a total of 338 subjects, 14 were identified harboring a total of 32 internal carotid artery mirror segment aneurysms that were treated with the pipeline embolization device and were consecutively enrolled into our study. We collected data on patient demographics, modified Rankin scale (mRS) at admission, aneurysm characteristics, clinical outcome at discharge, 3-9 and at 12-18 months as well as angiography results at follow-up...
August 6, 2018: Interventional Neuroradiology
Christoph J Griessenauer, Oded Goren, Shamsher S Dalal, Clemens M Schirmer
BACKGROUND: Thromboembolic complications remain a major reason for morbidity and mortality after flow diversion, in addition to hemorrhagic complications not limited to the brain predicated on the prolonged need for dual antiplatelet therapy. Surface modification to decrease thrombogenicity and accelerate aneurysm occlusion is a promising alteration to mitigate those risks. The Pipeline embolization device with Shield Technology possesses such characteristics; however, it has not yet been approved in the United States...
November 2018: World Neurosurgery
Timothy Hampton, Donal Walsh, Christos Tolias, David Fiorella
BACKGROUND: Flow-diverting stents have demonstrated great promise for the treatment of cerebral aneurysms; however, clinical experience with the devices remains very preliminary. We present two cases of spontaneous delayed complications-one fatal aneurysm rupture and one symptomatic increase in aneurysm volume-following the treatment of intradural aneurysms with the Pipeline Embolization Device (PED). PRESENTATION/INTERVENTION: Two patients with unruptured, intradural aneurysms of the carotid artery underwent uneventful treatment with the PED (eV3, Irvine, California, USA)...
July 2018: Journal of Neurointerventional Surgery
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