Safety of the Pipeline Embolization Device in Treatment of Posterior Circulation Aneurysms

Phillips, Timothy J; Wenderoth, Jason; Phatouros, Constantine C.; Rice, Hal; Singh, Tejinder; Devilliers, L.; Wycoco, Victor; Meckel, Stephan; McAuliffe, William

doi:10.3174/ajnr.a3166

Cited by 188 publications

(126 citation statements)

References 29 publications

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“…Phillips et al treated 32 posterior circulation aneurysms with the PED but reported perforator infarctions in 14%, with a permanent morbidity of 9.4%. 16 In this current series, only 1 case (a symptomatic cavernous aneurysm) of a large perforating vessel was seen to be occluded (ophthalmic artery) at angiographic follow-up after initially filling immediately post-stenting. The patient was not symptomatic, and at follow-up the collaterals from the external carotid artery continued to perfuse the orbital contents; the patient's vision remained normal.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

Monteith

Tsimpas²,

Dumont³

et al. 2014

JNS

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Object. Despite advances in surgical and endovascular techniques, fusiform aneurysms remain a therapeutic challenge. Introduction of flow-diverting stents has revolutionized the treatment of aneurysms with wide necks and of complex morphology. The authors report their experience with the endovascular treatment of fusiform aneurysms using the Pipeline Embolization Device.Methods. A retrospective review of 146 patients with cerebral aneurysms treated with the Pipeline Embolization Device between June 2011 and January 2013 was performed. Twenty-four patients were identified as having fusiform aneurysms. Twenty-four aneurysms in these 24 patients were treated. The mean patient age was 59 years. There were 9 men and 15 women. Angiographic and clinical data (including the modified Rankin Scale [mRS] score) were recorded at the time of treatment and at follow-up. The aneurysms were located in the internal carotid artery in 8 patients (33.3%), middle cerebral artery in 8 patients (33.3%), anterior cerebral artery in 1 patient (4%), and vertebrobasilar circulation in 7 patients (29%). The aneurysms were smaller than 10 mm in 3 patients, 10-25 mm in 16 patients, and larger than 25 mm in 5 patients. The mean largest dimension diameter was 18 mm.Results. Stent deployment was successful in all cases. The minor procedural morbidity was 4% (1 case). Morbidity and mortality related to aneurysm treatment were 4.2% and 4.2%, respectively. The mean mRS scores preoperatively and at clinical follow-up (median 6.0 months, mean 6.9 months) were 0.71 and 1.2, respectively (91.7% presented with an mRS score of 2 or better, and 79.2% had an mRS score of 2 or better at the 6.0-month follow-up). At clinical follow-up, 82.6% of patients were stable or had improved, 13.0% worsened, and 4.2% had died. Twentytwo (91.7%) of 24 patients had follow-up angiography available (mean follow-up time 6.3 months); 59% had excellent angiographic results (> 95% or complete occlusion), 31.8% had complete aneurysm occlusion, 27.3% had greater than 95% aneurysm occlusion, 18.2% had a moderate decrease in size (50%-95%), 4.5% had a minimal decrease in size (< 50%), 13.6% had not changed, and 4.5% had an increase in size.Conclusions. This series demonstrates that endovascular treatment of fusiform cerebral aneurysms with flow diversion was a safe and effective treatment. Procedural complications were low. Long-term morbidity and mortality rates were acceptable given the complex nature of these lesions.

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

Monteith

Tsimpas²,

Dumont³

et al. 2014

JNS

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“…We noted that in a great majority of single-center large series concerning stenting for intracranial aneurysms, an age range to include children was present (12,26,27). However, no information specific to the sizing of the devices or antiplatelet drug administration in children was provided in these series.…”

Section: Discussionmentioning

confidence: 99%

Angiographic morphometry of internal carotid circulation in turkish children

Arat¹,

Arat²,

Aydın³

2015

Turkish Neurosurgery

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AIm: Knowledge of cerebrovascular morphology is integral in planning neuroendovascular interventions, especially for procedures involving placement of stents, flow diverters or stentrievers. There is insufficient data on angiographic normative values of cerebral circulation in the pediatric age group since angiograms are uncommonly performed in children except for arteriovenous malformations in which arterial dimensions are larger than normal. We aimed to measure the diameters of internal carotid circulation (ICC) arteries on digital subtraction angiograms of pediatric patients and determine the growth trends. mATeRIAL and meTHods: This is a retrospective cross-sectional study measurements of ICC arteries of 64 pediatric patients (4 -122 months) with retinoblastoma undergoing intra-arterial chemotherapy.ResuLTs: Petrous, cavernous, supraclinoid and choroidal segments of internal carotid artery (ICA) and anterior cerebral artery (ACA) diameters had significant correlation with age. Most of the growth was noted in the first 36-48 months of life. Middle cerebral artery (MCA) diameter did not show significant correlation with age. 87% of the adult diameter of the MCA was attained in the first 6 months of life. ICC arteries reached 81% to 99% of adult sizes in the first 48 months of life. On the contrary, the main iliac artery was only 59% of the adult diameter at this age group.CoNCLusIoN: Use of current intracranial stents in children appears tolerable due to the growth pattern of ICC arteries. Based on this data, the current armamentarium of intracranial stents or stent-like devices is sufficient to cover the need in the pediatric population.KeywoRds: Cerebral arteries, Internal carotid artery, Diameter, Endovascular treatment, Stent, Flow diverter, Morphometry ÖZ AmAÇ: Nöroendovasküler girişimlerde, özellikle de stent, akım yönlendirici ve benzeri cihazlar kullanıldığında, serebrovasküler morfolojinin bilinmesi önemlidir. Serebral anjiyografi, arteryel boyutların normalden daha büyük olduğu arteriovenöz malformasyonlar dışında çocuklarda sık olarak yapılmadığından, pediatrik yaş gurubunda serebral dolaşımın anjiyografik normotif değerleri hakkında yeterli bilgi bulunmamaktadır. Çocuk hastalarda internal karotid dolaşımı (İKD) arterlerinin çaplarını ölçüp büyüme eğilimlerini belirlemeyi amaçladık. yÖNTem ve GeReÇLeR: Çalışmamız, retinoblastom için intraarteryel kemoterapi yapılan 64 çocuk hastada (yaş: 4 -122 ay) İKD arterlerinin ölçüldüğü retrospektif kesitsel bir çalışmadır.BuLGuLAR: İnternal karotid arterin petröz, kavernöz, supraklinoid ve koroidal segmentleriyle anterior serebral arter (ASA) çapları yaş ile anlamlı korelasyon göstermekteydi. Damarsal büyümenin 36-48 ayda tamamlanmaya yaklaştığı saptandı. Orta serebral arter (OSA) çapı yaş ile anlamlı korelasyon göstermedi. Bu arterde ilk 6 ayda arteryel çapın %87'sine ulaşıldığı izlendi. İKD arterlerinin 48 ay itibarıyla erişkin boylarının % 81-99'una ulaştığı görüldü. Bunun aksine ana iliak arter bu yaş gurubunda erişkin çapının sadece % 59'uydu. soN...

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“…Of the total of 32 aneurysms in the posterior circulation in the article by Phillips et al, 27 only 8 were located in the basilar trunk. No detailed information on aneurysm morphology or giant subtype was provided.…”

Section: Discussionmentioning

confidence: 99%

“…Data available in the literature on the use of flow-diverting stents, mostly case series, gave rise to optimism. In a series by Phillips et al, 27 32 aneurysms of the posterior circulation were treated with flow-diverting stents. Mean aneurysm size was 9.7 mm.…”

Section: Discussionmentioning

confidence: 99%

Use of Flow-Diverting Devices in Fusiform Vertebrobasilar Giant Aneurysms: A Report on Periprocedural Course and Long-Term Follow-Up

Ertl

Holtmannspötter

Patzig

et al. 2014

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Fusiform vertebrobasilar giant aneurysms are a rare (Ͻ1% of all intracranial aneurysms) but challenging aneurysm subtype. Little data are available on the natural history of this aneurysm subtype and the impact of the use of flow-diverting stents on the long-term clinical and imaging follow-up. In this article, we present our experience with the treatment of fusiform vertebrobasilar giant aneurysms by flow diverting stents. We aim to stimulate a discussion of the best management paradigm for this challenging aneurysm subtype.

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Safety of the Pipeline Embolization Device in Treatment of Posterior Circulation Aneurysms

Cited by 188 publications

References 29 publications

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

Angiographic morphometry of internal carotid circulation in turkish children

Use of Flow-Diverting Devices in Fusiform Vertebrobasilar Giant Aneurysms: A Report on Periprocedural Course and Long-Term Follow-Up

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