Treatment of Intracranial Aneurysms Using the Pipeline Flow-Diverter Embolization Device: A Single-Center Experience with Long-Term Follow-Up Results

Saatçi, Işıl; Yavuz, Kivilcim; Özer, Çiğdem; Geyik, Serdar; Cekirge, H Saruhan

doi:10.3174/ajnr.a3246

Cited by 353 publications

(298 citation statements)

References 56 publications

(89 reference statements)

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“…8,14 Treatment of fusiform aneurysms with endovascular flow diversion has been limited to a discussion in small case series or as a subgroup in larger series of all aneurysm types. 2,4,7,17,19,21 In a series by Siddiqui et al, 22 7 patients underwent flow diversion for large or giant fusiform vertebro- basilar aneurysms. The PED was used in 6 patients, and the Silk (Balt Extrusion) device was used in 1 patient.…”

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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“…Recent innovations in endovascular techniques are still continuing to offer new treatment alternatives for IA's. Long-term follow-up results of flow-diverting devices demonstrated a successful occlusion rates with low morbidity and mortality rates (25,27). Today, the management of IA's necessitates a multidisciplinary team…”

Section: Goksu E Et Al: Follow-up Screening Of Intracranial Aneurysmsmentioning

confidence: 99%

The analysis of long - term follow - up screening in patients with surgically treated intracranial aneurysms

Göksu¹,

Korkmaz²,

Akyuz³

et al. 2014

Turkish Neurosurgery

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AIM:To understand the late anatomical results of surgically treated intracranial aneurysms (IA's) and to investigate the incidence of recurrent, de novo aneurysms, the natural history of residual aneurysms, and the morphological changes in temporarily clipped vascular segments. MATErIAL and METHods:A total of 117 patients underwent screening with digital subtraction angiography (DSA) or computed tomographic angiography (CTA) in a range of 3 -13 years. Late angiographies were evaluated in terms of recurrence, change in known residua, the presence of de novo aneurysms and the morphological changes in temporarily clipped vessels. We also analysed the cumulative data including previously published results. rEsuLTs:In the long-term DSA, three residual aneurysms were observed to be enlarged while four remnants showed no morphological change. In one patient, spontaneous obliteration was seen. No recurrent aneurysm was detected. One de novo aneurysm was observed. We did not find any morphological change in 71 temporarily clipped vascular segments. CoNCLusIoN:Our data demonstrates that completely occluded aneurysms could remain stable even years later. Most of the small neck residues appeared to remain unchanged or even be thrombosed but they should be carefully followed. The incidence of de novo aneurysms might be expected to be lower.

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“…[1][2][3][4] Flow diverters limit aneurysmal blood flow but maintain blood flow into large vessels and perforating vessels covered by the device. 5 Although many in vitro and experimental models have demonstrated long-term patency rates of branch vessels covered by the PED, the long-term patency of major branch vessels is not well-established.…”

mentioning

confidence: 99%

Patency of the Anterior Choroidal Artery after Flow-Diversion Treatment of Internal Carotid Artery Aneurysms

Brinjikji¹,

Kallmes

Cloft

et al. 2014

AJNR Am J Neuroradiol

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Treatment of Intracranial Aneurysms Using the Pipeline Flow-Diverter Embolization Device: A Single-Center Experience with Long-Term Follow-Up Results

Abstract: BACKGROUND AND PURPOSE: Flow-diverting devices now offer a new treatment alternative for cerebral aneurysms. We present the results of a large single-center series of patients treated with the PED, including long-term follow-up.

Cited by 353 publications

References 56 publications

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

The analysis of long - term follow - up screening in patients with surgically treated intracranial aneurysms

Patency of the Anterior Choroidal Artery after Flow-Diversion Treatment of Internal Carotid Artery Aneurysms

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