Prolapse of the Pipeline embolization device in aneurysms: incidence, management, and outcomes

Srinivasan, Visish M.; Carlson, Andrew P.; Mokin, Maxim; Cherian, Jacob; Chen, Stephen R.; Puri, Ajit S; Kan, Peter

doi:10.3171/2017.3.focus1738

Cited by 21 publications

(23 citation statements)

References 28 publications

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“…Laser-cut mini stents have a higher radial force compared to flow diverters and consequently enable better flow diverter wall apposition. [ 10 15 ] We speculate that this translated into a higher occlusion rate in our series. Complete occlusion rates of commonly used flow diverters are reported to be around 66.6%–75% at 6 months.…”

Section: Discussionmentioning

confidence: 81%

“… The device was deployed along a fusiform or wide neck aneurysm, in which re-crossing of the freshly deployed device was deemed to be risky due to concerns related to stent migration into the aneurysm due to short landing zone [ , Supplemental Digital Content 2][ 11 ] After the device was deployed, it was realized that the proximal or distal landing zone was less than ideal, i.e., distance <6 mm or less than the diameter of the parent artery, which is not an ideal deployment [ Figure 1 ][ 14 15 ] The proximal or distal landing zones were around artery bends, leading to device malapposition, a situation that does not respond well to balloon angioplasty [ , Supplemental Digital Content 2][ 15 16 ] The distal end of the device was covering the origin of an intracranial major artery barely or partially, so that further expansion and apposition of the device would also lead to further shortening and subsequently unjailing of the specific arterial branch [ , Supplemental Digital Content 2] Previously placed endovascular devices which preclude the evaluation of optimal apposition (previously placed coils or stents) [ , Supplemental Digital Content 2]. [ 17 ] …”

Section: Resultsmentioning

confidence: 99%

“…After the device was deployed, it was realized that the proximal or distal landing zone was less than ideal, i.e., distance <6 mm or less than the diameter of the parent artery, which is not an ideal deployment [ Figure 1 ][ 14 15 ]…”

Section: Resultsmentioning

confidence: 99%

“…The proximal or distal landing zones were around artery bends, leading to device malapposition, a situation that does not respond well to balloon angioplasty [ , Supplemental Digital Content 2][ 15 16 ]…”

Section: Resultsmentioning

confidence: 99%

“…[ 21 ] Balloon angioplasty of the flow diverter was also shown to cause microthrombi formation along the device as well as distal embolization, and it may lead to excessive flow diverter shortening with consequent migration of the device into the aneurysm. [ 15 34 ] Finally, balloon angioplasty may not be effective for apposition of flow diverters when landing zones are at arterial bends. [ 17 ]…”

Section: Discussionmentioning

confidence: 99%

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The exchange-free technique: A novel technique for enhancing surpass flow diverter placement

Öcal

Arat

2020

Asian J Neurosurg

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Background: Following flow diverter placement, approximately 20% of intracranial aneurysms remain as residual aneurysms at 1 year. Device malapposition is a cause of residual aneurysms after flow diversion. We present a new and straightforward technique (exchange-free technique [EFT]) to enhance apposition of the surpass flow diverter (SFD), the only over-the-wire flow diverter currently available. Materials and Methods: We deployed laser-cut mini stents through the inner deployment catheter of the SFD. This maneuver was performed simply by withdrawing the micro-guidewire from its lumen and replacing it with a mini-stent (stents deliverable through microcatheters with inner diameter of 0.0165 inches), without a need to re-cross the deployed SFD or an exchange maneuver. All aneurysms in which this technique was utilized were retrospectively reviewed. Results: Twenty-eight patients (20 females) with 30 treated aneurysms were identified. The mean aneurysm diameter was 10.2 ± 6.6 mm. Technical success rate was 96.6% (29/30 aneurysms). There was no mortality or permanent morbidity related to the procedures. Except for the patient treated for an iatrogenic, surgery-related internal carotid artery pseudoaneurysm who died secondary to consequences of multiple surgeries, no cases of mortality or permanent morbidity were noted. Complete aneurysm occlusion rates were 78.2%, 82.1%, and 95.2% at 0–3, 3–6, and 9–12 months, respectively. None of the patients were re-treated. Conclusion: EFT is a simple and fast technique which was not associated with adverse effects in our series. The higher aneurysm obliteration rate obtained with EFT is probably the result of better wall apposition of the SFD.

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Section: Discussionmentioning

confidence: 81%