Flow Diverter Therapy With the Pipeline Embolization Device Is Associated With an Elevated Rate of Delayed Fluid-Attenuated Inversion Recovery Lesions

Safain, Mina G.; Roguski, Marie; Heller, Robert S.; Malek, Adel M.

doi:10.1161/strokeaha.115.010522

Cited by 24 publications

(29 citation statements)

References 30 publications

(38 reference statements)

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“…Fiorella and co‐workers used pipeline embolization device (PED) for the treatment of endovascular aneurysm. However, Safain et al observed the device is associated with increased rate of de novo fluid‐attenuated inversion recovery (FLAIR) lesions occurring in a delayed fashion and distinct from perioperative diffusion‐weighted imaging lesions. They concluded that cause and clinical effect of these lesions are unknown and suggested the need for prudent follow‐up and evaluation.…”

Section: Introductionmentioning

confidence: 99%

Bacterial Nanocellulose Magnetically Functionalized for Neuro‐Endovascular Treatment

Echeverry‐Rendón

Reece

Pastrana

et al. 2017

Macromolecular Bioscience

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Current treatments for brain aneurysms are invasive, traumatic, and not suitable in most patients with increased risks. A new alternative method is using scaffold stents to create a local and focal attraction force of cells for an in situ reconstruction of the tunica media. For this purpose, a nanostructured bioactive coating is designed to render an asymmetric region of the stent scaffold magnetic and biomimetic, which utilizes bacterial nanocellulose (BNC) as a platform for both magnetic and cell attraction as well as proliferation. The magnetization of the BNC is realized through the reaction of Fe III and II, precipitating superparamagnetic iron oxide nanoparticles (SPION). Subsequently, magnetic bacterial nanocellulose (MBNC) is coated with polyethylene glycol to improve its biocompatibility. Cytotoxicity and biocompatibility are evaluated using porcine aortic smooth muscle cells. Preliminary cellular migration assays demonstrate the behavior between MBNC and cells labeled with SPION. In this work, (1) synthesis of BNC impregnated with magnetic nanoparticles is successfully demonstrated; (2) a viable, resilient, and biocompatible hydrogel membrane is tested for neuroendovascular application using a stent scaffold; (3) cell viability and minimal cytotoxicity is achieved; (4) cell migration tests and examination of cellular magnetic attraction confirm the viability of MBNC as a multifunctional coating.

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Section: Introductionmentioning

confidence: 99%

Bacterial Nanocellulose Magnetically Functionalized for Neuro‐Endovascular Treatment

Echeverry‐Rendón

Reece

Pastrana

et al. 2017

Macromolecular Bioscience

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“…We also found that 22.2% of microbleeds in the PED group 6 months postprocedure occurred in areas distant from DWI lesions observed on day 1 postprocedure. Safain et al 28 demonstrated an association between PED and continued new and independent ipsilateral FLAIR signal abnormalities on MRI ≤ 1 year after PED treatment. These lesions were not associated with any previous abnormalities identified on DWI or FLAIR, suggesting that they may have been delayed ischemic events and were most likely embolic from the stent/aneurysm complex.…”

Section: Discussionmentioning

confidence: 99%

Microhemorrhagic transformation of ischemic lesions on T2*-weighted magnetic resonance imaging after Pipeline embolization device treatment

Nakae¹,

Nagaishi²,

Kawamura³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE The authors sought to demonstrate that hemorrhagic transformation of ischemic lesions is the main cause of delayed intracerebral hemorrhage (ICH) after Pipeline embolization device (PED) treatment and to estimate the rate of hemorrhagic transformation of new postprocedure ischemic lesions. METHODS Patients who underwent PED placement (PED group) from November 2015 to March 2017 or stent-mediated embolization (EN group) from December 2010 to October 2015 were retrospectively analyzed. Pre- and postprocedural MR images and 6-month follow-up MR images for each patient were scored for the presence of postprocedural bland ischemic and hemorrhagic lesions using diffusion-weighted MRI (DWI) and T2*-weighted MRI (T2*WI), respectively. RESULTS The PED group comprised 28 patients with 30 intracranial aneurysms, and the EN group comprised 24 patients with 27 intracranial aneurysms. The mean number of ischemic lesions on DWI 1 day postprocedure was higher in the PED group than in the EN group (5.2 vs 2.7, p = 0.0010). The mean number of microbleeds detected on T2*WI 6 months postprocedure was higher in the PED group than in the EN group (0.6 vs 0.15, p = 0.028). A total of 36.7% of PED-treated patients exhibited new microbleeds on T2*WI at 6 months postprocedure, with at least 77.8% of these lesions representing hemorrhagic transformations of the new ischemic lesions observed on day 1 postprocedure. The rate of adjunctive coil embolization (27.3% vs 0.0%, p = 0.016) and the mean number of ischemic lesions observed 1 day postprocedure (6.6 vs 4.3, p = 0.020) were predictors of subsequent microbleeds in the PED group. CONCLUSIONS New microbleeds detected using T2*WI at 6 months postprocedure were more common after PED treatment than after stent-mediated embolization. Approximately three-quarters of these lesions were hemorrhagic transformations of new ischemic lesions observed on day 1 postprocedure. Prevention of intraprocedural or postprocedural infarcts is necessary to reduce the risk of hemorrhagic complications following PED placement.

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“…6 Ipsilateral FLAIR changes of uncertain etiology and consequence have been identified in 34% of patients. 78 Higher rates of complications have been reported for the treatment of aneurysms in the posterior circulation and distal cerebral vasculature. 58 Rangel-Castilla et al 74 found a long-term rate of side-branch occlusion of 15.8% after flow-diverter treatment; however, these occlusions appeared to be clinically silent.…”

Section: Complications and Technical Difficultiesmentioning

confidence: 99%

Update on flow diverters for the endovascular management of cerebral aneurysms

Rajah

Narayanan

Rangel-Castilla

2017

Neurosurgical Focus

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Flow diversion has become a well-accepted option for the treatment of cerebral aneurysms. Given the significant treatment effect of flow diverters, numerous options have emerged since the initial Pipeline embolization device studies. In this review, the authors describe the available flow diverters, both endoluminal and intrasaccular, addressing nuances of device design and function and presenting data on complications and outcomes, where available. They also discuss possible future directions of flow diversion.

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Flow Diverter Therapy With the Pipeline Embolization Device Is Associated With an Elevated Rate of Delayed Fluid-Attenuated Inversion Recovery Lesions

Cited by 24 publications

References 30 publications

Bacterial Nanocellulose Magnetically Functionalized for Neuro‐Endovascular Treatment

Bacterial Nanocellulose Magnetically Functionalized for Neuro‐Endovascular Treatment

Microhemorrhagic transformation of ischemic lesions on T2*-weighted magnetic resonance imaging after Pipeline embolization device treatment

Update on flow diverters for the endovascular management of cerebral aneurysms

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