Retreatment of previously flow diverted intracranial aneurysms with the pipeline embolization device

Abstract

Background and Purpose Flow diversion of intracranial aneurysms with the Pipeline Embolization Device (PED) is frequently performed, but the outcomes of retreatment for aneurysms that failed to occlude after prior treatment with PED have not been well studied. Here, we report the safety and efficacy of PED retreatment after initial failure to occlude. Materials and Methods Clinical and angiographic data from eligible patients were retrospectively assessed for demographics, aneurysm occlusion status, and clinical outcomes. Patients were included in this study if they underwent PED retreatment to treat an aneurysm that had previously been treated with PED. Results Retreatment of previously flow-diverted aneurysms with PED was performed in 42 cases. At final angiographic follow-up, angiographic improvement was observed after 45% (19/42) of retreatments and complete aneurysm occlusion was observed following 26% (11/42). Significant clinical complications occurred in 10% (4/42) of PED retreatments. Conclusions Retreatment of intracranial aneurysms with PED following initial failure to achieve aneurysm occlusion has a low rate of subsequent complete aneurysm occlusion.

Repeat Flow Diversion for Retreatment of Incompletely Occluded Large Complex Symptomatic Cerebral Aneurysms: A Retrospective Case Series

“…26 Our results are more similar to another study of 42 patients (median aneurysm size 13 mm) by Lauzier et al, which demonstrated that repeat flow diversion of intracranial aneurysms was associated with a 26% rate of complete occlusion and only a 45% rate of improved aneurysmal filling at 14 months median followup. 27 The highest-quality evidence on this topic comes from a retrospective multicenter review of 95 patients (median aneurysm size 9 mm) by Salem et al, which demonstrated a 67% complete or near-complete occlusion rate after two-stage flow diversion. 28 In contrast to all previous studies, our study was focused on patients with large aneurysms (>10 mm) and demonstrates a 50% near-complete occlusion (OKM C) and 0% complete occlusion (OKM D).…”