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Pipeline stent

Sundeep Mishra
Currently drug eluting stents (DES) have reached a high degree of sophistication where there seems very little scope of improvement. Even so every year or so there is some advancement in technology and a new version is released, which is claimed to be a new generation (rather than pipeline innovation). It is really important to define what pipeline extension is and what is new innovation (generation)? This classification would not only be useful from regulatory perspective but also determining the true value of a product allowing for a correct pricing, which should ideally be able to mark-up for a real innovation...
September 2016: Indian Heart Journal
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
Ronak Dholakia, Chandramouli Sadasivan, David Fiorella, Henry Woo, B Barry Lieber
Cerebral aneurysms are pathological focal evaginations of the arterial wall at and around the junctions of the circle of Willis. Their tenuous walls predispose aneurysms to leak or rupture leading to hemorrhagic strokes with high morbidity and mortality rates. The endovascular treatment of cerebral aneurysms currently includes the implantation of fine-mesh stents, called flow diverters, within the parent artery bearing the aneurysm. By mitigating flow velocities within the aneurysmal sac, the devices preferentially induce thrombus formation in the aneurysm within hours to days...
October 11, 2016: Journal of Biomechanical Engineering
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
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
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
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
Demetri Adrahtas, Patrick Jasinski, George Koullias, David Fiorella, Apostolos Tassiopoulos
OBJECTIVE: To report a case of endovascular treatment of a complex renal artery aneurysm using the Pipeline Embolization Device, a flow diverting stent which is indicated for the treatment of large and giant cerebral aneurysms. CASE PRESENTATION: Forty-year old female with medically refractory hypertension and congenital agenesis of the right kidney was found to have a 2.8-cm left superior renal artery branch aneurysm. The patient was treated successfully using the Pipeline Embolization Device (PED, Medtronic, Irvine, CA) and coil embolization of the aneurysm and deconstruction of one outflow vessel...
July 6, 2016: Annals of Vascular Surgery
A Rouchaud, C Ramana, W Brinjikji, Y-H Ding, D Dai, T Gunderson, J Cebral, D F Kallmes, R Kadirvel
BACKGROUND AND PURPOSE: Robust wall apposition for flow-diverter stents may be important for endothelialization. Using a large series of experimental aneurysms treated with the Pipeline Embolization Device, the objectives of this study were to 1) assess interobserver agreement for the evaluation of wall apposition on posttreatment DSA and evaluate its association with aneurysm occlusion, and 2) measure the relationship between wall apposition assessed with histology and aneurysm occlusion rate after treatment...
July 7, 2016: AJNR. American Journal of Neuroradiology
Chao Wang, Zhongbin Tian, Jian Liu, Linkai Jing, Nikhil Paliwal, Shengzhang Wang, Ying Zhang, Jianping Xiang, Adnan H Siddiqui, Hui Meng, Xinjian Yang
BACKGROUND: The aim of this study was to quantify the effect of the new Low-profile Visualized Intraluminal Support (LVIS®D) device and the difference of fluid diverting effect compared with the Pipeline device and the Enterprise stent using computational fluid dynamics (CFD). METHODS: In this research, we simulated three aneurysms constructed from 3D digital subtraction angiography (DSA). The Enterprise, LVIS and the Pipeline device were virtually conformed to fit into the vessel lumen and placed across the aneurysm orifice...
July 2, 2016: Journal of Translational Medicine
P Bouillot, O Brina, H Yilmaz, M Farhat, G Erceg, K-O Lovblad, M I Vargas, Z Kulcsar, V M Pereira
BACKGROUND AND PURPOSE: Intracranial stents have become extremely important in the endovascular management of complex intracranial aneurysms. Sizing and landing zone predictions are still very challenging steps in the procedure. Virtual stent deployment may help therapeutic planning, device choice, and hemodynamic simulations. We aimed to assess the predictability of our recently developed virtual deployment model by comparing in vivo and virtual stents implanted in a consecutive series of patients presenting with intracranial aneurysms...
June 30, 2016: AJNR. American Journal of Neuroradiology
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
Brian P Walcott, Christopher J Stapleton, Omar Choudhri, Aman B Patel
IMPORTANCE: Brain aneurysms have traditionally been treated with surgical clipping or endovascular coiling techniques. With these modalities, many large or complex aneurysms remain difficult to treat. A new option, flow diversion, is now available to treat aneurysms. OBJECTIVE: To summarize the clinical progression of flow diversion technology, from an experimental treatment to a commonly used method to treat large or complex aneurysms. EVIDENCE REVIEW: References for this topical review were identified by searches of PubMed and GoogleScholar between January 2000 and January 2016...
August 1, 2016: JAMA Neurology
Hidenori Oishi, Kosuke Teranishi, Senshu Nonaka, Munetaka Yamamoto, Hajime Arai
Flow diversion stents (FDSs) are constructed from high-density braided mesh, which alters intra-aneurysmal hemodynamics and leads to aneurysm occlusion by inducing thrombus formation. Although there are potential complications associated with FDS embolization, one of the serious complications is the parent artery occlusion due to the in-stent thrombosis. A 72-year-old woman with a symptomatic giant fusiform aneurysm in the cavernous segment of ICA underwent single-layer pipeline embolization device (PED) embolization...
June 15, 2016: Neurologia Medico-chirurgica
Maksim Shapiro, Tibor Becske, Peter K Nelson
OBJECTIVE A detailed analysis was performed of anterior circulation aneurysms treated with a Pipeline Embolization Device (PED) that did not progress to complete occlusion by 1-year follow-up. Angiography was performed with the purpose of identifying specific factors potentially responsible for these failed outcomes. METHODS From among the first 100 patients with anterior circulation aneurysms, 92 underwent 1-year follow-up angiography and were individually studied through review of their pre- and postembolization studies...
May 6, 2016: Journal of Neurosurgery
Badih Daou, Nohra Chalouhi, Stavropoula Tjoumakaris, David Hasan, Guilherme Barros, Robert H Rosenwasser, Pascal Jabbour
OBJECTIVE: Data regarding the role of alternative access routes in neuro-endovascular interventions is limited. Our aim is to evaluate the safety and efficacy of alternative access in endovascular management of cerebrovascular diseases. METHODS: 29 patients who underwent endovascular interventions using alternative access techniques including transradial, transcervical with carotid cutdown and access through the superior ophthalmic vein (SOV) to manage various intracranial pathologies were retrospectively identified...
June 2016: Clinical Neurology and Neurosurgery
C M Wendl, H Henkes, R Martinez Moreno, O Ganslandt, H Bäzner, M Aguilar Pérez
PURPOSE: Retrospective evaluation of our experience with the use of flow diverters (FD) for the endovascular treatment of direct carotid-cavernous sinus fistulae (diCCF). METHODS: Between 2011 and 2015, 14 consecutive patients with 14 diCCF were treated with FD alone or in combination with other implants in a single institution. RESULTS: A total of 21 sessions were performed in 14 patients. FD placement was technically successful in all cases without an adverse event...
April 29, 2016: Clinical Neuroradiology
Emma F Sczudlo, Carolina Benavides-Baron, Joseph T Ho, George P Teitelbaum
We present three patients with dissecting and saccular aneurysms affecting the cervical carotid and vertebral arteries treated with flow diversion using the Pipeline Embolization Device (ev3 Endovascular Inc/Covidien, Plymouth, Minn). The device was successfully deployed in all three patients without complication. Follow-up imaging studies at 8 to 18 months revealed complete occlusion of all three aneurysms. This device may be a valuable alternative to stent-graft devices in the treatment of cervical aneurysms since it is delivered through a microcatheter that is better able to negotiate tortuous anatomy of cervical carotid and vertebral arteries...
May 2016: Journal of Vascular Surgery
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