Treatment of Ruptured Intracranial Aneurysms With the Pipeline Embolization Device

Chalouhi, Nohra; Zanaty, Mario; Whiting, Alexander C; Tjoumakaris, Stavropoula; Hasan, David; Ajiboye, Norman; Hann, Shannon; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.1227/neu.0000000000000586

Cited by 65 publications

(46 citation statements)

References 33 publications

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“…15 A procedure-related complication was seen in only 1 patient, who experienced an acute aneurysm rerupture, leading to her death. The occlusion rate was 80%, and 95% of patients had a favorable outcome (mRS score of 0-2) at most recent follow-up.…”

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confidence: 97%

Off-label uses of the Pipeline embolization device: a review of the literature

Patel

Chalouhi

Atallah

et al. 2017

Neurosurgical Focus

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The Pipeline embolization device (PED) is the most widely used flow diverter in endovascular neurosurgery. In 2011, the device received FDA approval for the treatment of large and giant aneurysms in the internal carotid artery extending from the petrous to the superior hypophyseal segments. However, as popularity of the device grew and neurosurgeons gained more experience, its use has extended to several other indications. Some of these off-label uses include previously treated aneurysms, acutely ruptured aneurysms, small aneurysms, distal circulation aneurysms, posterior circulation aneurysms, fusiform aneurysms, dissecting aneurysms, pseudoaneurysms, and even carotid-cavernous fistulas. The authors present a literature review of the safety and efficacy of the PED in these off-label uses.

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confidence: 97%

Off-label uses of the Pipeline embolization device: a review of the literature

Patel

Chalouhi

Atallah

et al. 2017

Neurosurgical Focus

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145

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Reports in the literature, however, are conflicting concerning the optimal strategy in using this new device. 1,2,4,13,15,16,[18][19][20][21] The addition of coil embolization to flow diversion, while prevalent in daily use, has not been subjected to a large systematic analysis. [7][8][9][10][11]16,[21][22][23][24] The earliest case report hypothesized that coils within the aneurysm sac can augment the degree of flow diversion with the goal of improved occlusion of the aneurysm.…”

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confidence: 99%

“…1,2,4,13,15,16,[18][19][20][21] The addition of coil embolization to flow diversion, while prevalent in daily use, has not been subjected to a large systematic analysis. [7][8][9][10][11]16,[21][22][23][24] The earliest case report hypothesized that coils within the aneurysm sac can augment the degree of flow diversion with the goal of improved occlusion of the aneurysm. 1 Others believe that adjunctive coil embolization does little to improve the already high occlusion rates obtained by using the Pipeline Embolization Device (PED; Covidien, Irvine, California) alone.…”

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confidence: 99%

Pipeline Embolization Device with or without Adjunctive Coil Embolization: Analysis of Complications from the IntrePED Registry

Park

Kilburg

Taussky

et al. 2016

AJNR Am J Neuroradiol

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SUMMARY: Flow diversion to treat cerebral aneurysms has revolutionized neurointerventional surgery. Because the addition of coils potentially increases the time and complexity of endovascular procedures, we sought to determine whether adjunctive coil use is associated with an increase in complications. Patients in the International Retrospective Study of Pipeline Embolization Device registry were divided into those treated with the Pipeline Embolization Device alone (n ϭ 689 patients; n ϭ 797 aneurysms; mean aneurysm size, 10.3 Ϯ 7.6 mm) versus those treated with the Pipeline Embolization Device and concurrent coil embolization (n ϭ 104 patients; n ϭ 109 aneurysms; mean aneurysm size, 13.6 Ϯ 7.8 mm). Patient demographics and aneurysm characteristics were examined. Rates of neurologic morbidity and mortality were compared between groups. The Pipeline Embolization Device with versus without coiling required a significantly longer procedure time (135.8 Ϯ 63.9 versus 96.7 Ϯ 46.2 min; P Ͻ .0001) and resulted in higher neurological morbidity (12.5% versus 7.8%; P ϭ .13). These data suggest that either strategy represents an acceptable risk profile in the treatment of complex cerebral aneurysms and warrants further investigation.

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“…Over 90% of patients had good neurological and angiographic outcomes in this study. 2 McAuliffe et al reported a series of 11 acutely ruptured aneurysms treated with the PED within 1 month of rupture. Of these aneurysms, 6 received concomitant coiling.…”

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confidence: 99%

Treatment of ruptured complex and large/giant ruptured cerebral aneurysms by acute coiling followed by staged flow diversion

Brinjikji¹,

Piano

Fang

et al. 2016

JNS

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OBJECT Flow-diversion treatment has been shown to be associated with high rates of angiographic obliteration; however, the treatment is relatively contraindicated in the acute phase following subarachnoid hemorrhage (SAH) as these patients require periprocedural dual antiplatelet therapy. Acute coiling followed by flow diversion has emerged as an intriguing and feasible treatment option for ruptured complex and giant aneurysms. In this study the authors report outcomes and complications of patients with ruptured aneurysms undergoing coiling in the acute phase followed by planned delayed flow diversion. METHODS This case series includes patients from 2 institutions. All patients underwent standard endovascular coiling in the acute phase after SAH with the intention and plan to proceed with flow diversion at a later date. Outcomes studied included angiographic occlusion, procedure-related complications, and long-term clinical outcome as measured using the modified Rankin Scale. RESULTS A total of 31 patients underwent coiling in the acute phase with the intention to undergo flow diversion at a later date. The mean aneurysm size was 15.8 ± 7.9 mm. Of the 31 patients undergoing coiling, 4 patients could not undergo further flow-diverter therapy: 3 patients (9.7%) died of complications of subarachnoid hemorrhage and 1 patient had permanent morbidity as a result of perioperative ischemic stroke (3.1%). Twenty-seven patients underwent staged placement of flow diverters after adequate recovery. The median time to treatment was 16 weeks. There was one case of aneurysm rebleeding following coil treatment. There were no cases of permanent morbidity or mortality resulting from flow-diverter treatment. Twenty-four patients underwent imaging follow-up; 18 of these patients had aneurysms that were completely or nearly completely occluded (58.1% on an intent-to-treat basis). At last follow-up (mean 18.3 months), 25 patients had mRS scores ≤ 2 (80.6% on an intent-to-treat basis). CONCLUSIONS Staged treatment of ruptured complex and giant intracranial aneurysms with coiling in the acute phase and flow-diverter treatment following recovery from SAH is both safe and effective. In this series, no cases of rebleeding occurred during the interval between coiling and flow diversion. This strategy should be considered as a valid option in patients presenting with these challenging ruptured aneurysms.

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Treatment of Ruptured Intracranial Aneurysms With the Pipeline Embolization Device

Cited by 65 publications

References 33 publications

Off-label uses of the Pipeline embolization device: a review of the literature

Off-label uses of the Pipeline embolization device: a review of the literature

Pipeline Embolization Device with or without Adjunctive Coil Embolization: Analysis of Complications from the IntrePED Registry

Treatment of ruptured complex and large/giant ruptured cerebral aneurysms by acute coiling followed by staged flow diversion

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