Diffusion weighted image documented cerebral ischemia in the postprocedural period following pipeline embolization device with shield technology treatment of unruptured intracranial aneurysms: a prospective, single center study

Abstract

ObjectiveAcute ischemic stroke and silent cerebral infarctions following pipeline embolization device (PED) treatment of intracranial aneurysms have been estimated to occur in 3–6% and in 50.9–90% of patients respectively. The PED with Shield technology (PED-Shield) incorporates a surface phosphorylcholine polymer to reduce the thrombogenicity of the implant. We sought to determine the incidence of diffusion weighted image (DWI) documented cerebral ischemia after PED-Shield treatment of unruptured intracranial aneurysms.MethodsThis prospective study involved a single center series of consecutive patients treated for an unruptured intracranial aneurysm with the PED-Shield. All participants underwent clinical evaluation on admission, after the procedure, at discharge, and 30 days following treatment. Brain MRI was obtained within 72 hours of the procedure. Ischemic lesions identified on DWI sequences where examined as to their number, size, and location in relation to the procedure.ResultsOver 12 months, 33 patients harboring 38 intracranial aneurysms were treated with the PED-Shield in 36 procedures. Neither mortality nor clinically evident ischemic events were noted in the 30 day postprocedural period. DWI documented, silent cerebral ischemia occurred in six patients (18.18%) after six procedures (16.66%). No statistically significant risk factors for postprocedural silent cerebral ischemia were identified.ConclusionWe demonstrated a reduced rate of silent cerebral infarcts following PED-Shield treatment of intracranial aneurysms than previously reported with other endovascular treatment modalities and with the previous device generations. Further research is necessary to evaluate our results and to identify methods to reduce the incidence of postprocedural cerebral ischemic events.

The Utility of Diffusion-Weighted MRI Lesions to Compare the Effects of Different Heparinization Schemes in Intracranial Aneurysms Treated by Endovascular Intervention

“…The use of new-generation blood flow guides can also reduce the incidence of such complications. Pikis et al (28) found that newgeneration blood flow guides significantly reduced the incidence of such complications in a study of 33 patients with unruptured aneurysms, with a DWI positive lesion rate of 16.66%, which also requires further study.…”

Diffusion-weighted imaging lesions after endovascular treatment of cerebral aneurysms: A network meta-analysis

“…Brasiliense et al found that the incidence of DWI-positive lesions after using a pipeline embolization device (PED), an FD stent, was 62.7% ( 37 ). Pikis et al even reported a DWI lesion incidence of up to 90.0% after FD stent treatment ( 38 ), whereas the incidence of symptomatic ischemic complications was reported at 0%–13% ( 39 ). In our study, we reported that the incidence of DWI lesions reached 66.1% among 165 patients who received FD stents.…”

“…Second, FD stent placement frequently requires auxiliary catheters with a large diameter and lengthy procedure time, which are also associated with increased catheter manipulation time and increased risk of catheter- and mechanical manipulation-related thromboembolic events ( 19 , 23 , 38 ).…”

Use of a p64 MW Flow Diverter with Hydrophilic Polymer Coating (HPC) and Prasugrel Single Antiplatelet Therapy for the Treatment of Unruptured Anterior Circulation Aneurysms: Safety Data and Short-term Occlusion Rates

“…Silent ischemic events were reported in as many as 50.9-90% of cases involving the implantation of the uncoated Pipeline FD [21][22][23][24]. In studies involving the newest version of the Pipeline FD (a phosphorylcholine polymer-coated Pipeline Shield), silent ischemic lesions were reported in 18.2% of the patients, all of whom were treated with DAPT [25].…”