Aneurysms with persistent filling after failed treatment with the Pipeline embolization device

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The Pipeline embolization device (PED) has become a valuable tool in the treatment of cerebral aneurysms. Although failures with PED treatment have been reported, the characteristics and course of these aneurysms remain a topic of uncertainty.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Electronic medical records and imaging studies were reviewed for all patients treated with the PED between July 2010 and March 2015 to identify characteristics of patients and aneurysms with residual filling after PED treatment.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Of 316 cases treated at a single institution, 281 patients had a long-term follow-up. A total of 52 (16.4%) aneurysms with residual filling were identified and constituted the study population. The mean patient age in this population was 58.8 years. The mean aneurysm size was 10.1 mm ± 7.15 mm. Twelve aneurysms were fusiform (23%). Of the aneurysms with residual filling, there were 20 carotid ophthalmic (CO) aneurysms (20% of all CO aneurysms treated), 10 other paraclinoid aneurysms (16.4% of all paraclinoid aneurysms), 7 posterior communicating artery (PCoA) aneurysms (21.9% of all PCoA aneurysms), 7 cavernous internal carotid artery (ICA) aneurysms (14.9% of all cavernous ICA aneurysms), 4 vertebrobasilar (VB) junction aneurysms (14.8% of all VB junction aneurysms), and 3 middle cerebral artery (MCA) aneurysms (25% of all MCA aneurysms). Eleven patients underwent placement of more than one PED (21.2%), with a mean number of devices of 1.28 per case. Eight of 12 aneurysms were previously treated with a stent (15.4%). Nineteen patients underwent re-treatment (36.5%); the 33 patients who did not undergo re-treatment (63.5%) were monitored by angiography or noninvasive imaging. In multivariate analysis, age older than 65 years (OR 2.65, 95% CI 1.33–5.28; p = 0.05), prior stent placement across the target aneurysm (OR 2.94, 95% CI 1.15–7.51; p = 0.02), aneurysm location in the distal anterior circulation (MCA, PCoA, and anterior choroidal artery: OR 2.72, 95% CI 1.19–6.18; p = 0.017), and longer follow-up duration (OR 1.06, 95% CI 1.03–1.09; p &lt; 0.001) were associated with incomplete aneurysm occlusion.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>While the PED can allow for treatment of large, broad-necked aneurysms with high efficacy, treatment failures do occur (16.4%). Aneurysm size, shape, and previous treatment may influence treatment outcome.</jats:p></jats:sec>

Relationship between haemodynamic changes and outcomes of intracranial aneurysms after implantation of the pipeline embolisation device: a single centre study

“…5 Nevertheless, some aneurysms remain unoccluded for a long time after PED treatment. 6 To date, there are no reliable means of predicting thrombosis of an aneurysm, and it is unknown how much flow reduction is needed to induce progressive thrombosis.…”

“…Interventional Neuroradiology 25 (6) the formula J ¼ 3 /cS 2 , where S is the specific surface area of coils, is the porosity of the medium, and c is the Kozeny coefficient (which is taken to be 2). The drag factor, C D , is determined by using standard C D versus Reynolds number diagrams, and was estimated to be 2.2.…”

“…Interventional Neuroradiology 25 (6) resulted in some changes in blood flow. Before treatment, complex flow patterns were present in 77.8% of aneurysms in the ICO group and 57.9% in the CO group (P ¼ 0.119, Table 1).…”

Avaliação das taxas de oclusão de aneurismas intracranianos tratados com dispositivo redirecionador de fluxo - a interferência dos ramos que se originam do interior do aneurisma

“…160 Aneurismas de localização distal estariam também mais associados à falha do tratamento. 189,190 Os aneurismas de maior tamanho seriam mais propensos a não ocluírem no controle de longo prazo. 189 Segundo Bender et al 184 A seguir, outros dois autores, em 2016 e 2017, relataram pequenas séries de casos de falência de aneurismas com a comunicante posterior envolvida.…”

“…160,192,193 Adicionalmente a tais fatores acima, a incorporação de uma artéria que emerge do interior do aneurisma, seja do colo ou do fundo, tem sido repetidamente relatada como um fator que potencialmente contribuiria para a falha do tratamento. 160,178,185,209 Em 2015, pela primeira vez, Kan et al 178 184,190 Conforme já discutido anteriormente, a incorporação de um ramo no interior do aneurisma tem sido repetidamente relatada como fator preditor de falha.…”