Thromboembolic complications with Pipeline Embolization Device placement: impact of procedure time, number of stents and pre-procedure P2Y12 reaction unit (PRU) value

Abstract

DWI changes on MRI occurred at a much higher rate than new neurological symptoms following PED placement. Longer procedure time and multiple PED deployment are associated with higher risks of new neurological changes due to thromboembolic events. There was a trend for an increased risk of a symptomatic thromboembolic event in patients with pre-procedural PRU values >208. Reloading (clopidogrel 600 mg) patients with preoperative PRU >208 was safe and may have a protective effect on thromboembolic events.

Flow Diverter Therapy With the Pipeline Embolization Device Is Associated With an Elevated Rate of Delayed Fluid-Attenuated Inversion Recovery Lesions

“…7 This high periprocedural rate has been replicated by an outside group with an almost identical rate of 50.9% when compared with 52% of patients in our initial study. 15 At this time, it is unclear whether this increased rate of imaging in a purely clinical setting may be feasible or practical unless it is shown to alter patient management strategies. It will be important, however, to further study these findings in a research setting to determine both the cause and the clinical impact, if any, that may be caused by the readily identifiable increased rate of FLAIR lesions with the PED.…”

“…7 This high periprocedural rate has been replicated by an outside group with an almost identical rate of 50.9% when compared with 52% of patients in our initial study. 15 In this light, we have elected to follow PED patients closely and assess them for delayed ischemic events. To study this, we analyzed all post-treatment and follow-up magnetic resonance images (MRI) for indications of delayed fluid-attenuated inversion recovery (FLAIR) lesions in a prospectively maintained database of both PED and Neuroformstent-mediated coil embolization of intracranial aneurysms.…”

Ex Vivo Release of Pipeline Embolization Device Polytetrafluoroethylene Sleeves: A Technical Note

“…5) However, this increases the risk of thrombus formation or vascular damage as well as complications such as breakage of the PED itself. In addition, Tan et al 9) reported that complications increased with prolongation of the procedure time. In our patient, the resistance was so strong that we could not even advance the delivery wire let alone attempt the maneuver to release the protective sleeves.…”

Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device

“…In a study of 96 patients who received a neurovascular (carotid or intracranial) stent, Fifi et al 9 found that clopidogrel-resistant patients had a significantly higher rate of thromboembolic events than those who were not resistant. In a study of 74 patients who underwent PED placement, Tan et al 12 found that having a level of Ͼ208 P2Y12 reaction units was associated with a non-statistically significant trend toward higher rates of symptomatic stroke on both univariate and multivariate analysis but no significant difference in infarcts as seen in diffusion-weighted MR imaging. Delgado Almandoz et al 13 found higher rates of stroke among patients with clopidogrel hyporesponse who underwent stentassisted coiling and PED placement and higher rates of hemorrhage among patients with clopidogrel hyperresponse.…”