The Pipeline Embolization Device

Jabbour, Pascal; Chalouhi, Nohra; Tjoumakaris, Stavropoula; Gonzalez, L. Fernando; Dumont, Aaron S.; Randazzo, Ciro; Starke, Robert M.; Hasan, David; Chitale, Rohan; Singhal, Saurabh; Moukarzel, Lea A.; Rosenwasser, Robert H.

doi:10.1227/01.neu.0000429844.06955.39

Cited by 127 publications

(36 citation statements)

References 9 publications

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“…Jabbour et al assessed the age, sex, aneurysm location, size, morphology, adjunctive use of coils, procedural complications and the angiographic follow-up time as predictors of aneurysm obliteration. 17 In their study, only fusiform aneurysms and a shorter follow-up duration negatively affected aneurysm occlusion rate. They also determined that the number of PEDs used was not a predictor of aneurysm obliteration, suggesting that the use of multiple PEDs provides no benefit in terms of angiographic obliteration, while unnecessarily increasing the procedural time, cost, and the risk of thromboembolic complications.…”

Section: Discussionmentioning

confidence: 86%

Factors Affecting the Obliteration Rate of Intracranial Aneurysms Treated with a Single Pipeline Embolization Device

et al. 2017

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Objective To evaluate the clinical and angiographic outcomes of intracranial aneurysm treatment using a single Pipeline Embolization Device (PED), and to evaluate the factors affecting aneurysm obliteration rate. Methods The demographic characteristics and anatomical features of 58 aneurysms in 47 patients treated with a single Pipeline embolization device were reviewed retrospectively. All aneurysms treated with one PED at a single center, and with follow-up angiograms of at least six months were included in this study. Results The overall rate of complete and near-complete occlusion was 84% (49/58) after a mean follow-up period of 18.3 months. The complete aneurysm obliteration rate was reduced when an arterial branch arose from the aneurysm neck; 13% (1/8) compared with 68% (34/50) for aneurysms without an arterial branch (P value: 0.0075). The overall complete and near-complete aneurysm occlusion rate was 90% (45/50) in aneurysms without an arterial branch arising from its neck. There was no statistically significant association between neck-width, aneurysm size, type, or history of prior coil embolization on obliteration rate. Conclusions Our data suggests that a single PED is sufficient to induce complete or near-complete obliteration of most aneurysms. The presence of a branching artery arising from the aneurysm neck is highly predictive of incomplete occlusion after treatment with a single PED.

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Section: Discussionmentioning

confidence: 86%

Factors Affecting the Obliteration Rate of Intracranial Aneurysms Treated with a Single Pipeline Embolization Device

et al. 2017

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“…In contrast to this study, Siddiqui et al reported less favorable results in a series of 7 large or giant vertebrobasilar fusiform aneurysms treated with flow diverters with significant morbidity and mortality; the poor outcome being secondary to post-treatment aneurysm ruptures in two and lack of neurological improvement caused by brainstem infarcts in another 2 patients [12]. Suboptimal outcome with the use of PED in fusiform aneurysms was also echoed in the study by Jabbour, et al in which they found fusiform aneurysm shape as a negative predictor for aneurysm obliteration despite a significantly higher number of PEDs (1.8) used in this subset of patients [10]. The variable results from different studies highlights the complexity associated with use of PED in vertebrobasilar fusiform aneurysms.…”

Section: Discussionmentioning

confidence: 95%

“…While the use of multiple PEDs appears intuitive in cases with fusiform aneurysms to decrease the shear stress on the diseased vessel wall, it may not obviate the chances of incomplete occlusion in these subgroup as seen in the study by Jabbour et al [10] and may unnecessarily increase procedural time, procedural cost, and the risk of thromboembolic complications [2]. On the other hand, a dense packing of the device during the implantation process does raise the degree of coverage resulting in larger flow diversion and a larger protective effect arguing in favor of implantation of more than one flow diverter across the orifice in order to increase the density with an improved flow diversion towards the parent artery.…”

Section: Discussionmentioning

confidence: 99%

“…While this approach may be useful for patients who does not presents with SAH, poor response with aneurysm regrowth in patients with SAH may be concerning due to risk of re-rupture as could have happened in our case. In these cases of fusiform aneurysm presenting with SAH, it may be prudent to utilize multiple PEDs to increase the coverage area; what is considered adequate is debatable and is up to the discretion of the treating neurointerventionlist as even with more than one PED, Jabbour et al [10] reported with poor outcome in patients with fusiform aneurysm. Hence considering an earlier follow up angiography in patients with fusiform aneurysms treated with PED especially in patients with SAH may be of value to detect increase in size of the aneurysm earlier and tailor the number of devices necessary to achieve the desired outcome or pursue alternative treatment modality to prevent aneurysm rupture.…”

Section: Discussionmentioning

confidence: 99%

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Persistent Aneurysm Growth Following Pipeline Embolization Device Assisted Coiling of a Fusiform Vertebral Artery Aneurysm: A Word of Caution!

2015

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The complex morphology of vertebrobasilar fusiform aneurysms makes them one of the most challenging lesions treated by neurointerventionists. Different management strategies in the past included parent vessel occlusion with or without extra-intracranial bypass surgery and endovascular reconstruction by conventional stents. Use of flow diversion has emerged as a promising alternative option with various studies documenting its efficacy and safety. However, there are various caveats associated with use of flow diversion in patients with fusiform vertibrobasilar aneurysms especially in patients presenting with acute subarachnoid hemorrhage (SAH). We report a rare case of persistent aneurysmal growth after coiling and placement of the Pipeline Embolization Device (PED; ev3, Irvine, California, USA) for SAH from a fusiform vertebral artery aneurysm. As consequences of aneurysm rupture can be devastating especially in patients with a prior SAH, the clinical relevance of recognizing and understanding such patterns of failure cannot be overemphasized as highlighted in the present case.

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“…A steep learning curve is well recognized in performing FD deployments, and the deployment procedure requires substantial technical ability. 23 This is especially true for complex deployment techniques like compacting or overlapping FDs.…”

Section: Discussionmentioning

confidence: 99%

Compacting a Single Flow Diverter versus Overlapping Flow Diverters for Intracranial Aneurysms: A Computational Study

Damiano

Tutino

Paliwal

et al. 2017

AJNR Am J Neuroradiol

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Background and Purpose Locally compacting the mesh of a flow diverter by a dynamic push-pull technique can accelerate intracranial aneurysm healing. We asked how this deployment strategy compares to overlapping two flow diverters in terms of aneurysmal flow reduction. Materials and Methods Using a high-fidelity virtual stenting method, we simulated three flow diverter strategies (single non-compacted, two overlapped, and single compacted) in three aneurysms (a fusiform, a large saccular, and a medium saccular). Computational fluid dynamics analysis provided post-treatment hemodynamic parameters including time-averaged inflow rate, aneurysm-averaged velocity, wall shear stress, total absolute circulation, and turnover time. We examined the relationship between the achieved degree of compaction and aneurysm orifice area. Results Flow diverter compaction resulted in a compaction coverage of 57%, 47%, and 22% over the orifice of the fusiform, large, and medium saccular aneurysm, respectively. Compaction coverage increased linearly with orifice area. In the fusiform aneurysm, the single compacted flow diverter accomplished more aneurysmal flow reduction than the other two strategies, as indicated by all five hemodynamic parameters. In the two saccular aneurysms, the overlapped flow diverters achieved the most flow reduction, followed by the single compacted and the non-compacted flow diverter. Conclusion Compacting a single flow diverter can outperform overlapping two flow diverters in aneurysmal flow reduction, provided that compaction produces a mesh denser than two overlapped flow diverters, and this denser mesh covers a sufficient portion of the aneurysm orifice area, to which we suggest a minimum of 50%. This strategy is most effective for aneurysms with large orifices, especially fusiform aneurysms.

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The Pipeline Embolization Device

Cited by 127 publications

References 9 publications

Factors Affecting the Obliteration Rate of Intracranial Aneurysms Treated with a Single Pipeline Embolization Device

Factors Affecting the Obliteration Rate of Intracranial Aneurysms Treated with a Single Pipeline Embolization Device

Persistent Aneurysm Growth Following Pipeline Embolization Device Assisted Coiling of a Fusiform Vertebral Artery Aneurysm: A Word of Caution!

Compacting a Single Flow Diverter versus Overlapping Flow Diverters for Intracranial Aneurysms: A Computational Study

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