Pipeline embolization device retraction and foreshortening after internal carotid artery blister aneurysm treatment

Heit, Jeremy J; Telischak, N; M., Huy; Dodd, Robert; Steinberg, Gary K.; Marks, Michael P.

doi:10.1177/1591019917722514

Cited by 11 publications

(7 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Poor wall attachment plays a significant role in the treatment of complex lesions, including immediate and delayed stent displacement or retraction ( Brinjikji et al, 2016 ; Heit et al, 2017 ). When this occurs, salvage of failed PED treatment is necessary.…”

Section: Discussionmentioning

confidence: 99%

Multiple Pipeline Embolization Devices for the Treatment of Complex Intracranial Aneurysm: A Multi-Center Study

Feng

Liu

et al. 2022

Front. Aging Neurosci.

View full text Add to dashboard Cite

BackgroundThe Pipeline for Uncoilable or Failed Aneurysms (PUFS) trial primarily demonstrated the safety and efficacy of the implantation of multiple pipeline embolization devices (multi-PEDs) for large/giant intracranial aneurysms. However, no study has focused on when, why, or how to apply multi-PEDs.ObjectiveThe purpose of this study was to investigate the indications and strategies of using multi-PEDs for complex intracranial aneurysms.MethodsPatients who had been treated with two or more PEDs were included in the post-market multicenter registry study from 2014 to 2019, across 14 centers in China. Indications, strategies, perioperative safety, and clinical outcomes were retrospectively analyzed. The modified Rankin scale (mRS) score was used to evaluate clinical outcomes comprehensively, and the O’Kelly–Marotta (OKM) grading scale was used to evaluate aneurysm healing results.ResultsA total of 55 intracranial aneurysms were treated with multi-PEDs. There were 20 fusiform aneurysms with a large range, 25 large/giant saccular aneurysms, six aneurysms with failed treatment, and four aneurysms with greatly varied diameters of the parent artery. The strategies included telescope techniques in 40 patients and overlap techniques in 15 patients. In total, 120 stents were deployed in 55 patients. The operation styles included 25 patients (55.6%) with two PEDs, 21 patients (38.2%) with two PEDs combined with coiling, four patients (7.3%) with three PEDs, four patients (7.3%) with three PEDs combined with coiling, and one patient (1.8%) with four PEDs. Angiography revealed OKM D in two, OKM C in seven, and OKM A and B in 46 cases after surgery. During the perioperative period, eight patients developed neurological dysfunction, three of whom died. A total of thirty-four patients were followed up with digital subtraction angiography for 2–45 (8.2 ± 8.0) months. Angiography revealed OKM D in 26, OKM C in five, and OKM B in three. At the last follow-up, the mRS score was 0–1 in 52 patients.ConclusionThe treatment of anterior circulation aneurysms with multi-PEDs is safe and effective. The implantation of multi-PEDs could be considered for large-scale fusiform aneurysms, large/giant saccular aneurysms with a jet-sign, salvage of failed PED treatments, and in cases where the diameter of the parent artery varies greatly.

show abstract

Section: Discussionmentioning

confidence: 99%

Multiple Pipeline Embolization Devices for the Treatment of Complex Intracranial Aneurysm: A Multi-Center Study

Feng

Liu

et al. 2022

Front. Aging Neurosci.

View full text Add to dashboard Cite

show abstract

“…ICA bifurcation is an uncommon location for a PED. To avoid PED retraction after treatment, it is necessary to deploy the end of the PED in the M1 segment and cover the origin of A1 [6,[9][10][11]. Sufficient preoperative evaluation is required for this off-label use, and previous reports have shown that approximately 2/3 of arteries covered by a flow diverter will become stenotic or occluded during follow-up [2].…”

Section: Discussionmentioning

confidence: 99%

Safety Evaluation and Flow Modification in the Anterior Cerebral Artery after Pipeline Embolization Device Deployment across the Internal Carotid Artery Terminus

Han

et al. 2021

BioMed Research International

View full text Add to dashboard Cite

Background and Objective. Whether anterior cerebral artery occlusion occurs after pipeline embolization devices (PEDs) are implanted to treat posterior communicating artery aneurysm is controversial. The purposes of this study were to explore the effect of a PED covering A1 on patients’ clinical prognosis and to evaluate the factors related to vascular occlusion. Method. The clinical and imaging data of PEDs in the postmarket multicenter registry study (PLUS) in China were retrospectively analyzed, and patients were divided into two groups on the basis of the follow-up angiographic results: group 1 (no significant change in A1 blood flow) and group 2 (A1 occlusion or decreased blood flow). We collected patients’ baseline data and evaluated the following imaging indicators: diameter and ratio of bilateral A1, M1, and internal carotid artery (ICA) vessels before stenting and the ratio of the PED size (sPED) to the ipsilateral ICA (I-ICA) diameter on the implantation side. Results. A total of 1171 patients were included, of whom 48 met the inclusion criteria (17 in group 1 and 31 in group 2). In group 2, three patients experienced neurological deterioration at follow-up. From the univariate analysis of outcomes, single PED without coils, incomplete aneurysm occlusion (IAO), maximum aneurysm diameter, aneurysms involving the ICA bifurcation (ICAb), and large sPED/I-ICA diameter ratio were included in the multivariate analysis ( P < 0.20 ). The multivariate regression analysis results showed that the ratio of sPED/I-ICA diameter was the factor influencing A1 vessel occlusion. The area under the ROC curve was 73.2%. When the sPED/I-ICA diameter ratio was 1.14, sensitivity was 70.6%, and specificity was 77.4%. Conclusion. When an oversized PED is placed from M1 to the ICA, the higher porosity formed at the covered A1 orifice is conducive to maintaining stable A1 blood flow and reducing the risk of A1 vessel occlusion. This trial is registered with ClinicalTrials.gov identifier: NCT03831672.

show abstract

“…The resolution of the vasospasm 15 days after endovascular therapy was mostly due to the increased diameter of the basilar trunk with delayed poor wall apposition of the FD and readmission of the patient to hospital due to occlusion of the perforating branches demonstrated by MRI. Since retraction of FDs in ruptured aneurysms has already been described in the literature,18 19 the identification of the exact timing of symptom onset, the appropriate timing of rPCPA treatment, intra-arterial infusion of nimodipine from the guide catheter as well as FD oversizing may reduce the risk of this ischemic complication in future.…”

Section: Discussionmentioning

confidence: 99%

Flow diverters for ruptured posterior circulation perforator aneurysms: multicenter experience and literature review

Ros¹,

Diana

Sabuzi

et al. 2020

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundThe management of ruptured posterior circulation perforator aneurysms (rPCPAs) remains unclear. We present our experience in treating rPCPAs with flow diverter stents (FDs) and evaluate their safety and efficacy at mid- to long-term follow-up. A diagnostic and therapeutic algorithm for rPCPAs is also proposed.MethodsWe retrospectively analyzed data from all consecutive patients with rPCPAs treated with FDs at our institutions between January 2013 and July 2019. Clinical presentations, time of treatments, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a mid- to long-term follow-up. A systematic review of the literature on rPCPAs treated with FDs was also performed.ResultsSeven patients with seven rPCPAs were treated with FDs. All patients presented with an atypical subarachnoid hemorrhage distribution and a low to medium Hunt–Hess grade. In 29% of cases rPCPAs were identified on the initial angiogram. In 57% of cases, FDs were inserted within 2 days of the diagnosis. Immediate aneurysm occlusion was observed in 14% of the cases and in 71% at the first follow-up (mean 2.4 months). At mean follow-up of 33 months (range 3–72 months) one case of delayed ischemic complication occurred. Six patients had a modified Rankin Scale (mRS) score of 0 and one patient had an mRS score of 4 at the latest follow-up.ConclusionsThe best management for rPCPAs remains unclear, but FDs seem to have lower complication rates than other treatment options. Further studies with larger series are needed to confirm the role of FDs in rPCPA.

show abstract

Pipeline embolization device retraction and foreshortening after internal carotid artery blister aneurysm treatment

Cited by 11 publications

References 11 publications

Multiple Pipeline Embolization Devices for the Treatment of Complex Intracranial Aneurysm: A Multi-Center Study

Multiple Pipeline Embolization Devices for the Treatment of Complex Intracranial Aneurysm: A Multi-Center Study

Safety Evaluation and Flow Modification in the Anterior Cerebral Artery after Pipeline Embolization Device Deployment across the Internal Carotid Artery Terminus

Flow diverters for ruptured posterior circulation perforator aneurysms: multicenter experience and literature review

Contact Info

Product

Resources

About