Tiny Pipes: 67 Cases of Flow Diversion for Aneurysms in Distal Vessels Measuring Less Than 2.0 mm

Bender, Matthew T.; Zarrin, David A.; Campos, Jessica K.; Lin, Li; Huang, Judy; Caplan, Justin M.; Tamargo, Rafael J.; Colby, Geoffrey P.; Coon, Alexander L.

doi:10.1016/j.wneu.2019.02.204

Cited by 25 publications

(16 citation statements)

References 23 publications

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“…With the expansion of indications to more distal aneurysms and the development of a newer generation of flow diverters, the application of these stent devices is likely to increase further. [1][2][3] Despite a growing body of literature on the use of the Pipeline embolization device (PED, Medtronic, Dublin, Ireland) and other flow diverters for IA treatment, the effect of multiple flow diverters in comparison to a single flow diverter on rates of aneurysm occlusion and thromboembolic complications is unclear. The use of multiple PEDs is thought to be associated with earlier occlusion but a higher rate of complications.…”

Section: Introductionmentioning

confidence: 99%

One and done? The effect of number of Pipeline embolization devices on aneurysm treatment outcomes

et al. 2019

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Background Controversy exists regarding the optimum number of flow diverters for the treatment of intracranial aneurysms. We explored the effect of the number of Pipeline embolization devices (PEDs; Medtronic, Dublin, Ireland) deployed on rates of aneurysm occlusion and complications. Methods Consecutive patients who underwent saccular intracranial aneurysm treatment solely with the PED were included in this retrospective study. Computed tomographic, magnetic resonance, or digital subtraction angiographic images at 6 and 12 months and last follow-up (>12 months) were reviewed for aneurysm occlusion. Complication and retreatment rates were recorded and analyzed statistically. Results The study included 141 aneurysm treatments in 119 patients. A single PED was deployed in 105 cases, two PEDs in 31 cases, and three PEDs in 5 cases (total = 182 devices). Six-month angiographic data were available for 103 patients. Occlusion rates were 67.1% for single-PED cases and 90.0% for cases with > 1 PED (p = 0.028). The 12-month occlusion rate (follow-up available for 132) for single-PED cases was 74.7% compared to 91.7% for multiple-PED cases (p = 0.04). On multivariate analysis, number of PEDs was an independent predictor of aneurysm occlusion at 12 months (odds ratio 6.3, 95% confidence interval 1.8–22.8, p = 0.005). Thromboembolic complication rates were the same in the single- and multiple-PED treatment groups (2.8%). The retreatment rate was higher in patients treated with a single PED (16.2% vs. 0%, p = 0.01). Conclusions Deployment of > 1 Pipeline embolization device was associated with higher intracranial aneurysm occlusion and lower retreatment rates. No significant difference was found in complication rates.

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Section: Introductionmentioning

confidence: 99%

One and done? The effect of number of Pipeline embolization devices on aneurysm treatment outcomes

et al. 2019

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“…There are some reports of the off-label use of a flow diverter in distal cerebral circulation. 10,[16][17][18] Figure 2. Angiographic description of the aneurysm.…”

Section: Discussionmentioning

confidence: 99%

“…Puri et al 18 and Bender et al 17 reported the efficiency and safety of using the flow diverter (Pipeline) for small vessels with diameters less than 2.5 mm and 2 mm, respectively.…”

Section: Discussionmentioning

confidence: 99%

Coiling for an unruptured saccular aneurysm at the non-branching segment of the distal anterior cerebral artery: Case report and literature review

et al. 2020

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Background Saccular aneurysms in the non-branching segment of the distal anterior cerebral artery (DACA) are extremely rare. Here, we describe the first case of coil embolization using a simple, non-adjunctive technique for an aneurysm at this rare location. Case description A 74-year-old man with an asymptomatic, unruptured aneurysm of the right DACA was followed up annually for 3 years by medical checkup. Endovascular treatment was proposed because of a slight angiographic change in the shape of the aneurysm in the past year. The aneurysm at the non-branching site of the right calloso-marginal artery was 2 mm distal to the origin, and measured 3 mm in height and 3.3 mm in width, with a neck measuring 1.7 mm wide; the calloso-marginal artery diameter was 1.6 mm. The aneurysm was successfully embolized with a simple technique using a Pre-Shaped S Microcatheter and two coils. Conclusions The simple, non-adjunctive technique for coil embolization of saccular side-wall type aneurysm in the non-branching segment of the DACA could be performed using the appropriate catheter and a softer coil.

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“…The major morbidity rate of 4.5% and mortality rate of 1.5% compare favourably to both on-label PED and small aneurysm PED series. 59…”

Section: Pipeline Embolization Devicementioning

confidence: 99%

“…60 In a series of 67 small-vessel aneurysms treated with FD, Bender et al reported five (7.5%) instances of intraprocedural stent thrombosis, all of which were successfully managed with intraprocedural abciximab dosing according to Lin et al's dosing strategy for the management of acute intraprocedural thromboembolic complications during PED treatment. 59 Intra-arterial (IA) abciximab (ReoPro) has been shown to be a safe and effective strategy for managing acute intraprocedural thromboembolic complications during PED treatment. Lin et al identified 30 cases where thromboembolic complications occurred during PED placement.…”

Section: Open Accessmentioning

confidence: 99%

Advances in endovascular aneurysm management: flow modulation techniques with braided mesh devices

et al. 2020

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Tiny Pipes: 67 Cases of Flow Diversion for Aneurysms in Distal Vessels Measuring Less Than 2.0 mm

Cited by 25 publications

References 23 publications

One and done? The effect of number of Pipeline embolization devices on aneurysm treatment outcomes

One and done? The effect of number of Pipeline embolization devices on aneurysm treatment outcomes

Coiling for an unruptured saccular aneurysm at the non-branching segment of the distal anterior cerebral artery: Case report and literature review

Advances in endovascular aneurysm management: flow modulation techniques with braided mesh devices

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