In-Pipeline Stenosis

Chalouhi, Nohra; Polifka, Adam; Daou, Badih; Kung, David; Barros, Guilherme; Tjoumakaris, Stavropula; Gonzalez, L. Fernando; Starke, Robert M.; Hasan, David; Judy, Brendan F.; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1227/neu.0000000000000908

Cited by 42 publications

(28 citation statements)

References 29 publications

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“…Moreover, no aspirin therapy and anterior circulation artery aneurysm location independently predicted in-PED stenosis. 38 In the present study, the rate of stenosis was comparable with those reported in the previous. The parent arteries were patent in 91.6%, 7.0% were stenotic, and 1.4% were occluded.…”

Section: Discussionsupporting

confidence: 92%

Pipeline Embolization Device for intracranial aneurysms in a large Chinese cohort: factors related to aneurysm occlusion

Luo

Kang

Zhang

et al. 2020

Ther Adv Neurol Disord

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Background and Purpose: The Pipeline Embolization Device (PED, Covidien/Medtronic) is widely used to treat intracranial aneurysms. This PED in China post-market multi-center registry study (PLUS) investigated safety and effectiveness of the PED for intracranial aneurysms in the Chinese population. Methods: This was a panoramic, consecutive, real-world cohort registry study. Patients treated with PED with or without coils between November 2014 and October 2019 at 14 centers in China were included, and those treated by parent vessel occlusion or other stents were excluded. Study outcomes included angiographic evaluation of aneurysm occlusion, complications, in-stent stenosis, and predictors of aneurysm occlusion. A central committee reviewed all imaging and endpoint events. Results: In total, 1171 patients with 1322 intracranial aneurysms were included. The total occlusion rate was 81.4% (787/967) at mean follow-up of 8.96 ± 7.50 months, with 77.1% (380/493) occlusion in the PED alone and 85.9% (407/474) in the PED plus coiling group. On multi-variate analysis, female sex, hyperlipidemia, vertebral aneurysms, PED plus coiling, and blood flow detained to venous phase were significant predictors of aneurysm occlusion. In posterior circulation cohort, there was no variable associated with aneurysm occlusion. In-stent stenosis predictors included current smoking and cerebral sclerosis/stenosis. Conclusion: In the largest series on PED of multi-center date of China, data suggest that treatment with the flow-diverting PED in intracranial aneurysms was efficacious. The treatment of PED combined coiling and blood flow detained to venous phase after PED implant were associated with aneurysmal occlusion. The occlusion rate of vertebral aneurysms was higher than other location aneurysms. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT03831672.

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Section: Discussionsupporting

confidence: 92%

Pipeline Embolization Device for intracranial aneurysms in a large Chinese cohort: factors related to aneurysm occlusion

Luo

Kang

Zhang

et al. 2020

Ther Adv Neurol Disord

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“…One study found that all patients were among the expected antiplatelet inhibition rate 33. The remaining studies did not report complications based on antiplatelet testing results, but 20 studies reported the action taken after abnormal results: two studies reported postponing procedures,34 35 three reported modification of the loading dose,36–38 eight reported switching to prasugrel/ticagrelor regimens,14 39–45 and seven studies reported switching to an alternative regimen 46–52. Another eight studies (335 patients) did not conduct antiplatelet testing at all and nine studies with 406 patients did not report the data on its usage (table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Thromboembolic complications are the most common cause of morbidity after these procedures, especially when flow diverting stents (FDS) are used 11 12. The 6-month incidence of in-stent thrombosis has ranged between 3.5% and 16% 13 14. In the meta-analysis by Bond et al , the incidence of new MR diffusion lesions following FDS placement was 67% (95% CI 46% to 85%) 15.…”

Section: Introductionmentioning

confidence: 99%

Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis

Podlasek

Sultan

Assis

et al. 2019

J NeuroIntervent Surg

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BackgroundThromboembolic complications are not uncommon in patients undergoing neurointerventional procedures. The use of flow diverting stents is associated with higher risks of these complications despite current dual antiplatelet regimens.ObjectiveTo explore contemporary evidence on the safety of emerging dual antiplatelet regimens in flow diverting stenting procedures.MethodsWe performed a systematic review and meta-analysis to identify relevant articles in electronic databases, and relevant references. Studies reporting the complications and mortality of flow diverting stenting procedures using acetyl salicylic acid (ASA) + ticagrelor or ASA + prasugrel compared with ASA + clopidogrel were included.ResultsOf 452 potentially relevant studies, we identified 49 studies (2526 patients) which reported the safety of ticagrelor or prasugrel for pooled analysis, and five studies (1005 patients) for meta-analysis. The pooled overall mortality in all studies was 2.14%, ischemic complications 6.89%, and hemorrhagic complications 3.68%. The use of ticagrelor or prasugrel was associated with a lower risk of mortality compared with clopidogrel (RR=4.57, 95% CI 1.23 to 16.99; p=0.02). Considering ischemic events, ASA + clopidogrel was as safe as ASA + prasugrel (RR=0.55, 95% CI 0.11 to 2.74; p=0.47) and ASA + ticagrelor (RR=0.74, 95% CI 0.32 to 1.74; p=0.49). ASA +ticagrelor was not associated with a higher risk of hemorrhagic complications (RR=0.92, 95% CI 0.27 to 3.16; p=0.89).ConclusionsEvidence suggests that dual antiplatelet regimens including ticagrelor or prasugrel are safe for patients undergoing flow diversion procedures. Regimens using ticagrelor were associated with better survival than those using clopidogrel in the included studies.

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“…Eleven (5.8%) patients required retreatment [20]. Chalouhi et al investigated in-stent stenosis in 139 patients treated using the PED (mean follow-up 6.7 months, range 3−24 months) and reported moderate/severe in-stent stenosis in 11 (7.9%) patients [21]. Martínez-Galdámez et al recently reported an 81.8% total aneurysm occlusion rate at first-year follow-up in their prospective study titled the PFLEX Study with Shield Technology.…”

Section: Discussionmentioning

confidence: 99%

The Pipeline Flex Embolization Device (PED Flex) for the treatment of intracranial aneurysms: Periprocedural outcomes and first-year angiographic results

Oguz¹,

Tabakci²,

Uysal³

et al. 2019

Turk J Med Sci

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Background/aim: The Pipeline Flex Embolization Device (PED Flex) is a new updated version of the PED classic that incorporates a new delivery system to allow facilitation of stent deployment, resheathing, and removal of the capture coil. This study evaluated the PED Flex in terms of the technical aspects of the procedure and first-year follow-up results. Materials and methods:This retrospective study involved prospectively collected data from May 2015 to August 2017. The primary endpoint was technical aspects of the procedure, and the secondary endpoint was first-year follow-up results.Results: Forty-nine patients with 59 target intracranial aneurysms were enrolled. Patients' mean age was 52 years (range 21−71 years), and 31 (63.0%) were female. All aneurysms except for three were unruptured. The mean aneurysm diameter was 8 mm. Forty-seven patients with 56 aneurysms were successfully treated. Due to advancement, repositioning, and migration problems, 8 (13.1%) stents were not deployed and discharged. The total aneurysm occlusion rate was 77.0%. The mortality rate was 4.3%. Conclusion: Our experience shows that the applicability and safety of the renewed delivery system provided by PED Flex for improving device apposition and opening has been proven with one-year angiographic and clinical follow-up results.

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In-Pipeline Stenosis

Abstract: IPS, in-Pipeline stenosisPED, Pipeline Embolization Device.

Cited by 42 publications

References 29 publications

Pipeline Embolization Device for intracranial aneurysms in a large Chinese cohort: factors related to aneurysm occlusion

Pipeline Embolization Device for intracranial aneurysms in a large Chinese cohort: factors related to aneurysm occlusion

Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis

The Pipeline Flex Embolization Device (PED Flex) for the treatment of intracranial aneurysms: Periprocedural outcomes and first-year angiographic results

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