Pipeline Diameter Significantly Impacts the Long-Term Fate of Jailed Side Branches during Treatment of Intracranial Aneurysms

Miller, Timothy; Kole, Matthew J; Le, Elizabeth; Cannarsa, Gregory; Jones, Salazar; Wessell, Aaron; Jindal, Gaurav; Aldrich, E. François; Simard, J. Marc; Gandhi, Dheeraj

doi:10.3174/ajnr.a5863

Cited by 14 publications

(10 citation statements)

References 17 publications

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“…ACA involvement was associated with the highest occlusion rate (63.64%) and proved to be a significant predictor ( p < 0.001, OR = 25.656) of branch occlusion according to the multivariate analysis. We also found that a smaller PED diameter was associated with branch occlusion ( p = 0.003, OR = 0.168), which had also been reported by Miller et al (15). They believed that smaller PEDs have greater metal density than larger devices and thus exert a higher blocking effect on the flow in branch arteries.…”

Section: Discussionsupporting

confidence: 90%

Patency of Branch Vessels After Pipeline Embolization: Comparison of Various Branches

Tian

et al. 2019

Front. Neurol.

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Objective: Pipeline embolization devices (PEDs) are widely used to exclude intracranial aneurysms from their parent arteries. Side branches covered by PEDs, however, sometimes experience occlusion and related symptoms. Thus, predictors of branch occlusion and the patency and clinical outcomes of these branches are concerning. Methods: We conducted a retrospective review of consecutive patients who had been treated with PEDs in our institution during 2015–2018 to identify those in whom one or more branches were involved. Pretreatment and follow-up angiograms were assessed to determine patency of the involved branches. Demographic and clinical data, treatment strategies, and comorbidities were collected to investigate their relations with branch occlusion. Results: Altogether, 173 branches [24 (13.9%) occluded), 29 (16.8%) with diminished flow] in 126 patients were studied. Five patients (OphA involved) presented with blurred vision and 1 patient (ACA involved) presented with headache. None of the other patients had neurologic complications or clinical strokes related to branch occlusion. Multivariate analysis identified that small PED diameter [ p = 0.003, odds ratio (OR) = 0.168], branches arising from the aneurysm ( p = 0.004, OR = 6.614), and involvement of the anterior cerebral artery (ACA) ( p < 0.001, OR = 25.656) significantly predicted branch occlusion. Conclusion: Branch occlusion rate after PED deployment was low and most occlusions was asymptomatic. Branches with rich collateral supply were more likely to occlude, especially the ACA. Smaller PED diameter, branches arising from the aneurysm, and ACA involvement were significant predictors of branch occlusion after PED treatment.

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Section: Discussionsupporting

confidence: 90%

Patency of Branch Vessels After Pipeline Embolization: Comparison of Various Branches

Tian

et al. 2019

Front. Neurol.

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“…In the present study, both LVIS stents and laser-cut SAC for saccular RIAs yielded lower perioperative procedural complication rates (5.6% and 14.0%, respectively) than the data above. Moreover, delayed stenosis and occlusion of the covered side branch, delayed aneurysm rebleeding and symptomatic cerebral infarction cannot be neglected for patients treated with FD [ 50 , 54 – 56 ]. In contrast, none of the patients in this study showed delayed occlusion/stenosis of the covered side branch and delayed aneurysm rebleeding during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of stent-assisted coiling for acutely ruptured wide-necked intracranial aneurysms: comparison of LVIS stents with laser-cut stents

et al. 2021

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Background To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms. Methods Patients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling (LVIS stent group) and laser-cut stent-assisted coiling (laser-cut stent group) were retrospectively reviewed from January 2014 to December 2017. Propensity score matching was used to adjust for potential differences in age, sex, aneurysm location, aneurysm size, neck width, Hunt-Hess grade, and modified Fisher grade. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared. Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors. Results A total of 142 patients who underwent LVIS stent-assisted coiling and 93 patients who underwent laser-cut stent-assisted coiling were enrolled after 1:2 propensity score matching. The angiographic follow-up outcomes showed that the LVIS stent group had a slightly higher complete occlusion rate and lower recurrence rate than the laser-cut stent group (92.7% vs 80.6%; 3.7% vs 9.7%, P = 0.078). The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences (P = 0.495 and P = 0.875, respectively). The rates of intraprocedural thrombosis, postprocedural thrombosis, postoperative early rebleeding, and procedure-related death were 0.7% (1/142), 1.4% (2/142), 2.8% (4/142), and 2.1% (3/142) in the LVIS stent group, respectively, and 4.3% (4/93), 2.2% (2/93), 1.1% (1/93), and 3.2% (3/93) in the laser-cut stent group, respectively (P = 0.082, 0.649, 0.651, and 0.683). Nevertheless, the rates of overall procedure-related complications and intraprocedural rupture in the LVIS stent group were significantly lower than those in the laser-cut stent group (5.6% vs 14.0%, P = 0.028; 0.7% vs 6.5%, P = 0.016). Multivariate analysis showed that laser-cut stent-assisted coiling was an independent predictor for overall procedure-related complications (OR = 2.727, P = 0.037); a history of diabetes (OR = 7.275, P = 0.027) and other cerebrovascular diseases (OR = 8.083, P = 0.022) were independent predictors for ischemic complications, whereas none of the factors were predictors for hemorrhagic complications. Conclusions Compared with laser-cut stent-assisted coiling, LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture.

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“…Similarly, inappropriate sizing may affect the patency of covered side branches which is more likely to occur when these devices are used in small vessels in the distal circulation. 25 These factors form a rationale for the development of flow diverters that are specifically targeted to smaller caliber vessels. The first clinical results of low-profile flow diverters are encouraging with a favorable safety and efficacy profiles and very infrequent in-stent stenosis and side branch occlusions, especially important in small cerebral vessels.…”

Section: Discussionmentioning

confidence: 99%

The p48 flow diverter: First clinical results in 25 aneurysms in three centers

et al. 2020

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Background The novel low-profile p48 flow diverter has been designed to treat aneurysms on small vessels of 1.75–3mm. We report our first clinical experiences. Methods Between March 2018–January 2020, 22 patients with 25 aneurysms were treated with the p48 in 3 centers. One patient had 3 aneurysms covered by one p48 and one patient had 2 aneurysms. There were 5 men, 17 women, with a mean age of 55 years (median 59, range 29–73 years). Results In 25 aneurysms, 24 p48 flow diverters were placed. In 1 patient additional coils were placed in the aneurysm. Procedural vessel rupture by the micro guidewire occurred in 2 patients and vessel rupture during p48 balloon dilatation occurred in 1 patient. Overall, the permanent morbidity rate was 13.6% (3 of 22, 95%CI 3.9–34.2%) and mortality was 4.5% (1 of 22, 95%CI <0.01–23.5%). Most complications were procedure-related and not device-specific. Of 22 patients with 25 aneurysms treated with p48, 18 patients with 20 aneurysms had angiographic follow-up after 5–18 months. Of 19 aneurysms, 10 were occluded and 7 showed a remnant. Two aneurysms were open after 6 months. Three aneurysms were still not occluded after 12, 14, and 18 months and these 3 were retreated. Retreatment rate was 16% (3 of 19) and the adequate occlusion rate was 90% (17 of 19). Conclusions Treatment of aneurysms in small-caliber vessels with the p48 is feasible and effective but is not without complications. More data is needed to establish indications, safety, and efficacy more accurately.

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Pipeline Diameter Significantly Impacts the Long-Term Fate of Jailed Side Branches during Treatment of Intracranial Aneurysms

Cited by 14 publications

References 17 publications

Patency of Branch Vessels After Pipeline Embolization: Comparison of Various Branches

Patency of Branch Vessels After Pipeline Embolization: Comparison of Various Branches

Safety and efficacy of stent-assisted coiling for acutely ruptured wide-necked intracranial aneurysms: comparison of LVIS stents with laser-cut stents

The p48 flow diverter: First clinical results in 25 aneurysms in three centers

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