Management of In-Stent Stenosis with Dual Antiplatelet Therapy Following Pipeline Embolization of Intracranial Aneurysms

Lauzier, David C.; Cler, Samuel J.; Osbun, Joshua W.; Chatterjee, Arindam; Moran, Christopher J.; Kansagra, Akash P.

doi:10.1016/j.wneu.2022.08.002

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Note that current treatment for ISS remains empirical. 30 For patients with ISS, close follow-up and long-term antiplatelet therapy are recommended. If the blood vessel is nearly completely occluded and causes symptoms, angioplasty, stent reimplantation, or even bypass surgery can be used to relieve blood vessel narrowing.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes and dynamic changes of in-stent stenosis after Pipeline embolization device treatment of intracranial aneurysms

Gui

Chen

Wei

et al. 2023

J NeuroIntervent Surg

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BackgroundFlow diverters have revolutionized the treatment of intracranial aneurysms. However, the delayed complications associated with flow diverter use are unknown.ObjectiveTo evaluate the incidence, severity, clinical outcomes, risk factors, and dynamic changes associated with in-stent stenosis (ISS) after treatment with a Pipeline embolization device (PED).MethodsPatients who underwent PED treatment between 2015 and 2020 were enrolled. The angiographic, clinical, and follow-up data of 459 patients were independently reviewed by four neuroradiologists to identify ISS. Binary logistic regression was conducted to determine ISS risk factors, and an ISS–time curve was established to demonstrate dynamic changes in ISS after PED implantation.ResultsOf the 459 treated patients, 69 (15.0%) developed ISS. At follow-up, nine patients (2.0%) with ISS demonstrated reversal, while 18 (3.9%) developed parental artery occlusion. A total of 380 patients (82.8%) achieved complete aneurysm occlusion (O’Kelly–Marotta grade D). Patients with posterior-circulation aneurysm (OR=2.895, 95% CI (1.732 to 4.838; P<0.001) or balloon angioplasty (OR=1.992, 95% CI 1.162 to 3.414; P=0.037) were more likely to develop ISS. Patients aged >54 years (OR=0.464, 95% CI 0.274 to 0.785; P=0.006) or with a body mass index of >28 kg/m2(OR=0.427, 95% CI 0.184 to 0.991; P=0.026) had a lower ISS risk. Intimal hyperplasia initiated by PED placement peaked within 1 year after the procedure, rarely progressed after 12 months, and tended to reverse within 24 months.ConclusionsISS is a common, benign, and self-limiting complication of PED implantation in the Chinese population.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes and dynamic changes of in-stent stenosis after Pipeline embolization device treatment of intracranial aneurysms

Gui

Chen

Wei

et al. 2023

J NeuroIntervent Surg

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“…Novel microcatheters and microwires have enabled operators to catheterize distal vascular territories that were previously inaccessible ( 119 ). A growing understanding of appropriate uses of antiplatelet therapies have assisted in mitigating both hemorrhagic and ischemic complications after certain embolization procedures ( 120 – 122 ). Finally, optimization of follow-up protocols after aneurysm treatment have eliminated low-value follow-ups, minimized patient risks associated with cerebral angiography, and mitigated the perception of unnecessary barriers to appropriate care ( 123 , 124 ).…”

Section: Discussionmentioning

confidence: 99%

A review of technological innovations leading to modern endovascular brain aneurysm treatment

et al. 2023

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“…Among the articles focusing on in-stent stenosis, in-stent stenosis rates were reported in 54% for the PED by You et al and in 44% for the SILK (Balt Extrusion, Montmorency, France) by Essbaiheen et al [18,29] Although in-stent stenoses are mild in the majority of cases and usually improve over time, neointimal hyperplasia is associated with endothelial cell and platelet activation, which can be a source of thromboembolism or lead to parent vessel occlusion, potentially causing delayed ischemic stroke [30]. To avoid this risk, we continue DAPT in cases with in-stent stenosis, as suggested by other authors, while reserving balloon angioplasty or stenting for severe or symptomatic cases [31]. In the present study, in-stent stenosis was observed in 9.5%, which is lower than the rates reported for PED and SILK.…”

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confidence: 97%

Long-term Safety and Efficacy of the Derivo Embolization Device in a Single-center Series

Goertz,

Zopfs,

Kottlors

et al. 2024

Clin Neuroradiol

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Purpose This study analyzes the long-term clinical and angiographic outcomes of the Derivo Embolization Device (DED), an advanced flow diverter device with an electropolished surface, for the treatment of intracranial aneurysms. Methods A consecutive series of 101 patients (mean age: 58 years, 72% female) treated with the DED for 122 aneurysms at a single center between 2017 and 2023 was retrospectively analyzed for major (change in National Institutes of Health Stroke Scale [NIHSS] score ≥ 4 points) and minor (change in NIHSS score < 4 points) neurological events, procedural morbidity (increase of at least one point on the modified Rankin Scale), and angiographic results. Results There were 14 (11%) recurrent aneurysms, 15 (12%) ruptured aneurysms, 26 (21%) posterior circulation aneurysms and 16 (13%) fusiform or dissecting aneurysms. Device deployment failed in 1 case (1%). Procedure-related symptomatic procedural complications consisted of 2 (2%) major events (1 major stroke and 1 vessel perforation with intracranial hemorrhage and infarction) and 6 minor events (6 minor strokes). Procedural morbidity was 5%. There were no late ischemic or hemorrhagic events during follow-up. Complete and favorable aneurysm occlusion was achieved in 54% (40/74) and 62% (46/74) at a mean of 5 months, 71% (27/38) and 87% (33/38) at a mean of 12 months, and 76% (25/33) and 97% (32/33) at a mean of 35 months, respectively. Conclusion The results demonstrate progressive aneurysm occlusion beyond 12 months after DED implantation with an almost 100% favorable occlusion rate. Procedural morbidity was low and there were no late complications.

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Management of In-Stent Stenosis with Dual Antiplatelet Therapy Following Pipeline Embolization of Intracranial Aneurysms

Cited by 3 publications

References 11 publications

Long-term outcomes and dynamic changes of in-stent stenosis after Pipeline embolization device treatment of intracranial aneurysms

Long-term outcomes and dynamic changes of in-stent stenosis after Pipeline embolization device treatment of intracranial aneurysms

A review of technological innovations leading to modern endovascular brain aneurysm treatment

Long-term Safety and Efficacy of the Derivo Embolization Device in a Single-center Series

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