Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

Bohara, Manoj; Teranishi, Kosuke; Yatomi, Kenji; Fujii, Takashi; Kitamura, Takayuki; Yamamoto, Munetaka; Oishi, Hidenori

doi:10.1177/1591019918809932

Cited by 7 publications

(5 citation statements)

References 14 publications

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“… 4 However, the use of multiple PEDs has been correlated with device migration/foreshortening and limits control of pore density and porosity of the PED with unknown effects on flow diversion, all of which may interfere with long-term aneurysm occlusion. 5 Bohara et al 6 described the recurrence of a giant ICA aneurysm between PED segments at the 4-year follow-up despite angiographic occlusion at the 3-year follow-up. Coxon et al 7 reported on a recurrent MCA fusiform aneurysm with areas of dilation, which had previously been surgically treated.…”

Section: Discussionmentioning

confidence: 99%

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Recurrence of a large intracranial fusiform aneurysm treated with overlapping Pipeline embolization devices: illustrative case

Kumar,

Dabhi,

Raper

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Flow diversion, specifically with the Pipeline embolization device (PED), represents a paradigm shift in the treatment of intracranial aneurysms. Several studies have demonstrated its efficacy and at times superiority to conventional treatment modalities for aneurysms with a fusiform morphology, giant size, or wide neck. However, there may be a nonsignificant risk of recurrence after flow diversion of these historically difficult-to-treat aneurysms, relative to aneurysms with a more favorable morphology and size (i.e., saccular, narrow necked). To date, only three papers in the literature have demonstrated the recurrence of a completely occluded aneurysm on follow-up. OBSERVATIONS The authors describe a patient with a giant middle cerebral artery fusiform aneurysm treated with multiple telescoping PEDs. On the 3-month follow-up angiogram, there was complete occlusion of the aneurysm. The patient was lost to follow-up and presented 4 years later with a recurrence of the aneurysm between PED segments, requiring retreatment. The patient represented 3 years posttreatment with the need for repeat treatment of the fusiform aneurysm due to separation of the existing PEDs along with stent reconstruction. At the 20-month follow-up after the third treatment, the initial aneurysm target was found to be occluded. LESSONS This case illustrates the need for long-term follow-up, specifically for patients with giant wide-necked or fusiform aneurysms treated with overlapping PEDs.

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Section: Discussionmentioning

confidence: 99%

“…3 However, only a few studies in the literature have described the recurrence of a once completely occluded fusiform aneurysm on follow-up. [6][7][8]…”

mentioning

confidence: 99%

Recurrence of a large intracranial fusiform aneurysm treated with overlapping Pipeline embolization devices: illustrative case

Kumar,

Dabhi,

Raper

et al. 2023

Journal of Neurosurgery: Case Lessons

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“…describe a patient with a large aneurysm treated successfully with telescoping Pipeline devices that upon follow up was noted to recur. In both cases, recanalization was attributed to device migration resulting in uncovering of the aneurysm neck [ 1 , 2 ]. Trivelato et al.…”

Section: Discussionmentioning

confidence: 99%

A case of recurrent aneurysm resulting from dual antiplatelet plus anticoagulation after confirmed aneurysm closure following coil-assisted flow diversion

Geisbush

Pulli²,

Wolman

et al. 2022

Radiology Case Reports

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“…A second case of recurrence has been reported, but the recurrence was attributed to stent migration and exposure of the aneurysm neck. 5 After reviewing the rarity of this situation and discussing the risks and benefits of interval treatment, the patient elected to undergo placement of a second PED across the neck of the recurrent aneurysm (19 months post-treatment, not shown). In anticipation of the procedure, she was restarted on dual antiplatelet therapy as prior.…”

mentioning

confidence: 99%

“…A second case of recurrence has been reported, but the recurrence was attributed to stent migration and exposure of the aneurysm neck. 5…”

mentioning

confidence: 99%

Aneurysmal recurrence after successful flow-diversion embolization

et al. 2022

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Aneurysmal recurrence after successful flow-diversion embolization is exceptionally rare. The rarity of recurrence has called into question the yield of interval surveillance imaging. Here we report the case of a recurrent intracranial aneurysm despite complete angiographic resolution after flow-diversion therapy with a Pipeline embolization device (PED). Given the absence of poor wall apposition, endoleak, and device migration, how this aneurysm recurred remains unclear, particularly given the recurrence was at a timepoint at which complete reendothelialization of the device would be expected. The patient ultimately underwent interval treatment with a second device placed across the neck of the aneurysm. Although rare, reports of aneurysmal recurrences support the use of interval non-invasive imaging surveillance to ensure successful embolization in this patient population.

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Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

Cited by 7 publications

References 14 publications

Recurrence of a large intracranial fusiform aneurysm treated with overlapping Pipeline embolization devices: illustrative case

Recurrence of a large intracranial fusiform aneurysm treated with overlapping Pipeline embolization devices: illustrative case

A case of recurrent aneurysm resulting from dual antiplatelet plus anticoagulation after confirmed aneurysm closure following coil-assisted flow diversion

Aneurysmal recurrence after successful flow-diversion embolization

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