Fate of the Ophthalmic Artery After Treatment With the Pipeline Embolization Device

Chalouhi, Nohra; Daou, Badih; Kung, David; Zanaty, Mario; Phillips, Jessica; Tjoumakaris, Stavropoula; Starke, Robert M.; Hasan, David; Polifka, Adam; Salas, Sussan J.; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1227/neu.0000000000000887

Cited by 43 publications

(28 citation statements)

References 23 publications

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“…They reported that arterial occlusion occurred in 7% of patients, decreased flow occurred in 4%, whereas arterial patency was maintained in 89% of patients. 6 Occlusion was symptomatic in 1 patient only. Larger vessels such as the PCoA and the ophthalmic artery usually have well-developed distal collaterals.…”

Section: Discussionmentioning

confidence: 96%

“…3,18,21 The higher rate of ophthalmic artery patency after flow diversion can probably be attributed to a higher continued physiological demand with the ophthalmic than the PCoA. 6 Furthermore, because both systems have an adequate collateral circulation, clinical symptoms do not usually develop in occluded arteries and in arteries with diminished flow.…”

Section: Discussionmentioning

confidence: 99%

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Patency of the posterior communicating artery following treatment with the Pipeline Embolization Device

Daou

Valle-Giler

Chalouhi

et al. 2017

JNS

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OBJECTIVE The Pipeline Embolization Device (PED) has become an effective treatment strategy for some cerebral aneurysms. Concerns regarding the patency of branch arteries have been raised. The objective of this study was to assess the patency of the posterior communicating artery (PCoA) following treatment of PCoA aneurysms using the PED. METHODS All patients with PCoA aneurysms treated with the PED who had angiographic follow-up were retrospectively identified. The patency of the PCoA at follow-up was evaluated by 2 authors who were not involved in the intervention. Univariate and multivariate analyses were performed to identify factors associated with the following: 1) PCoA patency versus no or diminished flow, and 2) PCoA patency and diminished flow versus PCoA occlusion. RESULTS Thirty patients with an angiographic follow-up of 6 months were included. Aneurysm obliteration was achieved in 25 patients (83.3%). The PCoA was patent in 7 patients (23.3%), had diminished flow in 7 patients (23.3%), and was occluded in 16 patients (53.3%). In the univariate analysis of outcome, there was a trend for aneurysms with incomplete occlusion, aneurysms not previously treated, those with presence of a fetal PCoA, and those with an artery coming from the aneurysm to have higher odds of the PCoA remaining patent. In univariate and multivariate analyses of factors associated with outcome, fetal PCoA and presence of an artery coming from the aneurysm were associated with the PCoA remaining open with or without diminished flow. No patients had symptoms related to PCoA occlusion. CONCLUSIONS Occlusion and diminished flow through the PCoA is common following PED treatment of PCoA aneurysms. However, it is clinically insignificant in most cases.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Patency of the posterior communicating artery following treatment with the Pipeline Embolization Device

Daou

Valle-Giler

Chalouhi

et al. 2017

JNS

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“…Greater aneurysm volume was significantly correlated with decreased flow of the OphA after the FDS procedure, and had a marginal correlation with increased flow of the distal ICA after the FDS procedure (AUC, p=0.060). Similarly, Chalouhi et al 5 reported that larger aneurysms carried a higher risk of OphA occlusion. We postulated that a larger aneurysm stole more turbulent flow in the aneurysm sac.…”

Section: Discussionmentioning

confidence: 88%

Quantitative flow measurement after placing a flow diverter for a distal internal carotid artery aneurysm

Chen

Wong

et al. 2016

J NeuroIntervent Surg

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“…15 Likewise, rational approaches to building both single-and multidevice 16 constructs that maximize desired metal coverage of the aneurysm while minimizing coverage of adjacent perforator and other hazards have been outlined both by our group and others. 17,18 The fates of some covered branches, such as the ophthalmic, 19 anterior choroidal, 20 and posterior communicating 9 arteries have been extensively examined, highlighting the critical role of collateral support in determining the long-term patency of covered branches. The unifying message is that good collaterals frequently lead to progressive occlusion of jailed branches, both in humans and in specifically designed animal models.…”

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confidence: 99%

“…The unifying message is that good collaterals frequently lead to progressive occlusion of jailed branches, both in humans and in specifically designed animal models. [17][18][19][20] Unfortunately, quantifying the efficiency of collateral support at a given time point and estimating its subsequent change are extremely difficult. Likewise, the study of hemodynamic changes in aneurysms and adjacent covered branches is made difficult by the daunting complexity of in vivo fluid dynamics.…”

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confidence: 99%

Toward Better Understanding of Flow Diversion in Bifurcation Aneurysms

Shapiro¹,

Shapiro

Raz³

et al. 2018

AJNR Am J Neuroradiol

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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. MATERIALS AND METHODS:Fundamental electric and fluid dynamics principles were applied to generate equations describing the relationships between changes in flow and the degree of vessel coverage in settings of variable collateral support to the jailed territory. Given the high complexity of baseline and posttreatment fluid dynamics, in vivo, we studied a simplified hypothetic system with minimum assumptions to generate the most conservative outcomes. RESULTS:In the acute setting, Pipeline Embolization Devices modify flow in covered branches, principally dependent on the amount of coverage, the efficiency of collateral support, and intrinsic resistance of the covered parenchymal territory. Up to 30% metal coverage of any branch territory is very likely to be well-tolerated regardless of device or artery size or the availability of immediate collateral support, provided, however, that no acute thrombus forms to further reduce jailed territory perfusion. CONCLUSIONS:Basic hemodynamic principles support the safety of branch coverage during aneurysm treatment with the Pipeline Embolization Device. Rational strategies to build bifurcation constructs are feasible. ABBREVIATIONS: FD ϭ flow diverter; PcomA ϭ posterior communicating artery; PED ϭ Pipeline Embolization Device

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Fate of the Ophthalmic Artery After Treatment With the Pipeline Embolization Device

Abstract: Treatment of internal carotid artery aneurysms with the PED preserves the patency of the OA in most cases. The occlusion of the OA in the few cases where it occurs is usually a clinically irrelevant event. Minimizing the number of PEDs across the OA is crucial to preserve its patency.

Cited by 43 publications

References 23 publications

Patency of the posterior communicating artery following treatment with the Pipeline Embolization Device

Patency of the posterior communicating artery following treatment with the Pipeline Embolization Device

Quantitative flow measurement after placing a flow diverter for a distal internal carotid artery aneurysm

Toward Better Understanding of Flow Diversion in Bifurcation Aneurysms

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