Pipeline Embolization Device in the Treatment of Recurrent Previously Stented Cerebral Aneurysms

Daou, Badih; Starke, Robert M.; Chalouhi, Nohra; Tjoumakaris, Stavropoula; Hasan, David; Khoury, Jean; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.3174/ajnr.a4613

Cited by 44 publications

(46 citation statements)

References 21 publications

(29 reference statements)

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“…5,8,14,16,[19][20][21] While this has been described in numerous reports, 3 published studies directly evaluated the safety and efficacy of PED in this subset of recurrent aneurysms (Table 3). In achieving complete aneurysm occlusion, reported efficacy ranged from 38% to 65%, a significantly lower rate than would be expected in PED use for treatment-naïve aneurysms.…”

Section: Ped Following Failed Stent-assisted Coilingmentioning

confidence: 99%

“…In achieving complete aneurysm occlusion, reported efficacy ranged from 38% to 65%, a significantly lower rate than would be expected in PED use for treatment-naïve aneurysms. 8,14,16 The incidence of significant adverse neurological sequelae tends to be substantially higher for previously stented aneurysms as well. Such sequelae, including transient ischemic attacks and major ischemic and hemorrhagic events, were observed in 8%-14.3% of cases.…”

Section: Ped Following Failed Stent-assisted Coilingmentioning

confidence: 99%

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Pipeline embolization device for recurrence of previously treated aneurysms

Dornbos

Karras

Wenger

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe utilization of the Pipeline embolization device (PED) has increased significantly since its inception and original approval for use in large, broad-necked aneurysms of the internal carotid artery. While microsurgical clipping and advances in endovascular techniques have improved overall efficacy in achieving complete occlusion, recurrences still occur, and the best modality for retreatment remains controversial. Despite its efficacy in this setting, the role of PED utilization in the setting of recurrent aneurysms has not yet been well defined. This study was designed to assess the safety and efficacy of PED in the recurrence of previously treated aneurysms.METHODSThe authors reviewed a total of 13 cases in which patients underwent secondary placement of a PED for aneurysm recurrence following prior treatment with another modality. The PEDs were used to treat aneurysm recurrence or residual following endovascular coiling in 7 cases, flow diversion in 2, and microsurgical clipping in 4. The mean time between initial treatment and retreatment with a PED was 28.1 months, 12 months, and 88.7 months, respectively. Clinical outcomes, including complications and modified Rankin Scale (mRS) scores, and angiographic evidence of complete occlusion were tabulated for each treatment group.RESULTSAll PEDs were successfully placed without periprocedural complications. The rate of complete occlusion was 80% at 6 months after PED placement and 100% at 12 months in these patients who underwent PED placement following failed endovascular coiling; there were no adverse clinical sequelae at a mean follow-up of 26.1 months. In the 2 cases in which PEDs were placed for treatment of residual aneurysms following prior flow diversion, 1 patient demonstrated asymptomatic vessel occlusion at 6 months, and the other exhibited complete aneurysm occlusion at 12 months. In patients with aneurysm recurrence following prior microsurgical clipping, the rate of complete occlusion was 100% at 6 and 12 months, with no adverse sequelae noted at a mean clinical follow-up of 27.7 months.CONCLUSIONSThe treatment of recurrent aneurysms with the PED following previous endovascular coiling, flow diversion, or microsurgical clipping is associated with a high rate of complete occlusion and minimal morbidity.

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Section: Ped Following Failed Stent-assisted Coilingmentioning

confidence: 99%

Section: Ped Following Failed Stent-assisted Coilingmentioning

confidence: 99%

Pipeline embolization device for recurrence of previously treated aneurysms

Dornbos

Karras

Wenger

et al. 2017

Neurosurgical Focus

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“…24 In a series of 21 previously stented aneurysms, the complete occlusion rate after PED placement was found to be 55.6% and the complication rate was 14.3%. 23 In this second study, the authors compared these results with a group of patients who underwent PED placement for aneurysms not previously stented. They concluded that the PED was less effective in managing previously stented aneurysms compared with nonstented aneurysms, and can also be associated with a higher complication rate in the previously treated aneurysms.…”

Section: Previously Treated Aneurysmsmentioning

confidence: 99%

“…This same group later looked at subsets of patients with recurrent aneurysms that were previously coiled and previously stented. 23,24 One study followed 32 patients with single lesions who had recurrence of previously coiled aneurysms, and investigators found a total rate of complete and near-complete occlusion of 86.7%, a complication rate of 3%, and no mortalities. 24 In a series of 21 previously stented aneurysms, the complete occlusion rate after PED placement was found to be 55.6% and the complication rate was 14.3%.…”

Section: Previously Treated Aneurysmsmentioning

confidence: 99%

Off-label uses of the Pipeline embolization device: a review of the literature

Patel

Chalouhi

Atallah

et al. 2017

Neurosurgical Focus

141

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The Pipeline embolization device (PED) is the most widely used flow diverter in endovascular neurosurgery. In 2011, the device received FDA approval for the treatment of large and giant aneurysms in the internal carotid artery extending from the petrous to the superior hypophyseal segments. However, as popularity of the device grew and neurosurgeons gained more experience, its use has extended to several other indications. Some of these off-label uses include previously treated aneurysms, acutely ruptured aneurysms, small aneurysms, distal circulation aneurysms, posterior circulation aneurysms, fusiform aneurysms, dissecting aneurysms, pseudoaneurysms, and even carotid-cavernous fistulas. The authors present a literature review of the safety and efficacy of the PED in these off-label uses.

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“…Recanalization and recurrence after coiling as well as aneurysm persistence after flow diversion (FD) are a problem in spite of these contemporary technologies [6]. There is a limited reference literature for the use of FD as salvage therapy for aneurysms in this setting [7-9]. This study assesses the safety and effectiveness of the PED as a salvage treatment for persistent and recurrent aneurysms that were previously treated with either VRD or FD.…”

Section: Introductionmentioning

confidence: 99%

Pipeline Embolization for Salvage Treatment of Previously Stented Residual and Recurrent Cerebral Aneurysms

Bender¹,

Vo²,

Jiang³

et al. 2018

Intervent Neurol

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Introduction: This study assessed the safety and effectiveness of the Pipeline embolization device (PED) for persistent and recurrent aneurysms previously treated with either a vascular reconstruction device (VRD) or a flow diverter (FD). Methods: A prospective, IRB-approved database was analyzed for patients treated with PED for aneurysms previously treated with a stent. Results: Twenty procedures were performed on 18 patients, 11 with prior FD, 7 with VRD, and 2 previously treated with both. Overall, 15 aneurysms were saccular (75%), and size was 13.5 ± 7.6 mm. Location was internal carotid artery (ICA) in 14 cases (70%) and posterior circulation in 6 cases (30%). Average prior treatments were 1.7. Previously FD cases were re-treated at an average of 18.1 months from most recent treatment. Each case used 1 device, 82% with distal coverage and 82% with proximal coverage of prior stent. Balloon remodeling was performed in 3 cases (27%) and no in-stent thrombosis was observed. Previously VRD stent-coiled cases were re-treated at an average of 87.5 months. These cases used on average 1.9 devices, 89% with distal and 100% proximal coverage. Adjunctive coiling was performed in 1 case (11%), balloon remodeling in 5 cases (56%), and 2 cases (28%) developed thrombosis that resolved with abciximab. Re-VRD cases were longer (59.1 vs. 33.7 min, p = 0.02) than re-FD. Angiographic follow-up was available for 16 cases (80%). In re-FD, occlusion was complete in 56% and partial progressive in 33% at 17.1 months digital subtraction angiography. In re-VRD, occlusion was complete in 57% and partial progressive in 27% at 8.1 months. Two complications occurred (10%), including one asymptomatic cervical ICA occlusion and one stent occlusion with associated mortality (5%). Clinical follow-up was 17.8 months on average (range 0.5–51.9). Conclusions: Salvage flow diversion for previously stented aneurysms is technically challenging but offers good prospects of aneurysm obliteration with acceptable complication rates.

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Pipeline Embolization Device in the Treatment of Recurrent Previously Stented Cerebral Aneurysms

Cited by 44 publications

References 21 publications

Pipeline embolization device for recurrence of previously treated aneurysms

Pipeline embolization device for recurrence of previously treated aneurysms

Off-label uses of the Pipeline embolization device: a review of the literature

Pipeline Embolization for Salvage Treatment of Previously Stented Residual and Recurrent Cerebral Aneurysms

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