Letter: Commentary: Radial Artery Access for Treatment of Posterior Circulation Aneurysms Using the Pipeline Embolization Device: Case Series

2019 ◽  
Vol 17 (4) ◽  
pp. E186-E187
Author(s):  
Stephanie H Chen ◽  
Marie-Christine Brunet ◽  
Brian T Jankowitz ◽  
Pascal Jabbour ◽  
Eric C Peterson
Keyword(s):  
Radial Artery ◽  
Case Series ◽  
Posterior Circulation ◽  
Pipeline Embolization Device ◽  
Posterior Circulation Aneurysms

Radial Artery Access for Treatment of Posterior Circulation Aneurysms Using the Pipeline Embolization Device: Case Series

2019 ◽  
Vol 17 (4) ◽  
pp. 340-347 ◽  
Author(s):  
Eytan Raz ◽  
Maksim Shapiro ◽  
Razvan Buciuc ◽  
Peter Kim Nelson ◽  
Erez Nossek
Keyword(s):  
Case Series ◽  
Vascular Anatomy ◽  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Femoral Access ◽  
Pipeline Embolization Device ◽  
Aneurysm Treatment ◽  
Posterior Circulation Aneurysm ◽  
Device Placement ◽  
Posterior Circulation Aneurysms

AbstractBACKGROUNDThe treatment of selected wide-neck and fusiform posterior circulation aneurysms is challenging for clipping as well as for endovascular route.OBJECTIVETo describe an endovascular approach for vertebral artery aneurysm treatment using transradial access (TRA) instead of the conventional transfemoral access.METHODSWe collected cases from two institutions in which TRA was used for posterior circulation Pipeline Embolization Device (Medtronic, Dublin, Ireland) deployment.RESULTSA total of four patients were treated. TRA was useful in the setting of extreme vessel tortuosity. We utilized 5F Terumo Glidesheath (Terumo Medical, Somerset, New Jersey), intermediate catheter, and a 027 microcatheter for Pipeline deployment. TRA was not associated with any access or deployment difficulties.CONCLUSIONSEarly experience suggests that TRA for Pipeline Embolization Device placement for posterior circulation aneurysm is a safe and efficient alternative to standard transfemoral access. While this approach was initially applied to patients with vascular anatomy that may not allow for safe femoral access or navigation, experience so far argues for considering a radial approach towards some posterior circulation aneurysm treatment.

scholarly journals Safety of the Pipeline Embolization Device in Treatment of Posterior Circulation Aneurysms

2012 ◽  
Vol 33 (7) ◽  
pp. 1225-1231 ◽  
Author(s):  
T.J. Phillips ◽  
J.D. Wenderoth ◽  
C.C. Phatouros ◽  
H. Rice ◽  
T.P. Singh ◽  
...  
Keyword(s):  
Posterior Circulation ◽  
Pipeline Embolization Device ◽  
Posterior Circulation Aneurysms

scholarly journals The safety of Pipeline flow diversion in fusiform vertebrobasilar aneurysms: a consecutive case series with longer-term follow-up from a single US center

2016 ◽  
Vol 125 (1) ◽  
pp. 111-119 ◽  
Author(s):  
Sabareesh K. Natarajan ◽  
Ning Lin ◽  
Ashish Sonig ◽  
Ansaar T. Rai ◽  
Jeffrey S. Carpenter ◽  
...  
Keyword(s):  
Case Series ◽  
Dissecting Aneurysm ◽  
Posterior Circulation ◽  
Flow Diversion ◽  
Single Center Experience ◽  
Vertebrobasilar Artery ◽  
Delayed Hemorrhage ◽  
Posterior Circulation Aneurysms ◽  
Previously Treated

OBJECT Pessimism exists regarding flow diversion for posterior circulation aneurysms because of reports of perforator territory infarcts and delayed ruptures. The authors report the results of patients who underwent Pipeline Embolization Device (PED) flow diversion using novel strategies for treatment of fusiform posterior circulation aneurysms, and compare these results with those from previously reported series. METHODS The authors conducted a retrospective review of data from consecutive patients with fusiform vertebrobasilar artery aneurysms treated with the PED. RESULTS This review resulted in the identification of 12 such patients (mean [± SD] age 55.1 ± 14.1 years). Eleven patients had symptoms; 1 had a dissecting aneurysm identified on imaging for neck pain. The average aneurysm size was 13.25 ± 4.5 mm. None of the aneurysms were ruptured or previously treated. The average clinical follow-up duration was 22.1 ± 10.7 months and radiological follow-up was 14.5 ± 11.1 months from the index PED treatment. One patient suffered a perforator stroke and had a modified Rankin Scale (mRS) score of 4 at last follow-up. Another patient had a retained stent pusher requiring retrieval via surgical cut-down but recovered to an mRS score of 0 at last follow-up. Eleven (91.7%) of 12 patients recovered to an mRS score of 0 or 1. Two patients had aneurysmal remnants at 7 and 10 months, respectively, after the index PED, which were retreated with PEDs. At last follow-up, all 12 aneurysms were occluded and PEDs were patent. The minimum follow-up duration was 12 months from the index PED treatment; no patient experienced delayed hemorrhage, stroke, or in-stent stenosis. CONCLUSIONS Flow diversion with selective adjunctive techniques is evolving to become a safer treatment option for posterior circulation aneurysms. This is the longest clinical follow-up duration reported for a single-center experience of flow-diversion treatment of these aneurysms.

Trapped Fourth Ventricle Phenomenon Following Aneurysm Rupture of the Posterior Circulation

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 253-258 ◽  
Author(s):  
Manuel Ferreira ◽  
Brian V. Nahed ◽  
Maya A. Babu ◽  
Brian P. Walcott ◽  
Richard G. Ellenbogen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fourth Ventricle ◽  
Case Series ◽  
Aneurysm Rupture ◽  
Posterior Circulation ◽  
Shunt System ◽  
Cerebrospinal Fluid Diversion ◽  
Isolated Fourth Ventricle ◽  
Posterior Circulation Aneurysms ◽  
Trapped Fourth Ventricle

Abstract BACKGROUND AND IMPORTANCE Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. CLINICAL PRESENTATION A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal cerebrospinal fluid diversion. These patients had no evidence of infection of the cerebrospinal fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal cerebrospinal fluid diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. CONCLUSION Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal cerebrospinal fluid diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.

A reappraisal of the Pipeline embolization device for the treatment of posterior circulation aneurysms

2014 ◽  
Vol 7 (9) ◽  
pp. 641-645 ◽  
Author(s):  
Felipe C Albuquerque ◽  
Min S Park ◽  
Adib A Abla ◽  
R Webster Crowley ◽  
Andrew F Ducruet ◽  
...  
Keyword(s):  
Posterior Circulation ◽  
Pipeline Embolization Device ◽  
Posterior Circulation Aneurysms

Morbidity and Mortality in Patients With Posterior Circulation Aneurysms Treated With the Pipeline Embolization Device: A Subgroup Analysis of the International Retrospective Study of the Pipeline Embolization Device

Neurosurgery ◽  
2017 ◽  
Vol 83 (3) ◽  
pp. 488-500 ◽  
Author(s):  
Demetrius K Lopes ◽  
Dong-Kyu Jang ◽  
Saruhan Cekirge ◽  
David Fiorella ◽  
Ricardo A Hanel ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Primary Endpoint ◽  
Subgroup Analysis ◽  
Univariate Analysis ◽  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Pipeline Embolization Device ◽  
Aneurysm Size ◽  
Neurological Morbidity ◽  
Posterior Circulation Aneurysms

Abstract BACKGROUND The safety of PipelineTM Embolization Device (PED; Medtronic Inc, Dublin, Ireland) in posterior circulation aneurysms is still controversial. OBJECTIVE To study complications associated with the treatment of posterior circulation aneurysms by conducting a subgroup analysis from the International Retrospective Study of PED registry. METHODS Data from 91 consecutive patients with 95 posterior circulation aneurysms at 17 centers between July 2008 to February 2013 were analyzed. The primary endpoint was defined as any complication leading to neurological morbidity or death. The outcome predictors were calculated using Kaplan–Meier and Cox regression methods. RESULTS The mean aneurysm size was 13.8 mm. Aneurysm types were saccular (36.8%), fusiform (29.5%), dissecting (28.4%), and others (5.3%). The median follow-up was 21.1 mo. Twelve (13.2%) patients encountered a primary endpoint event. In multivariate analysis for the primary endpoint, use of ≥3 PEDs and fusiform shape compared with other shapes had hazard ratios (HRs) of 7.77 (95% confidence interval [CI], 2.48-25.86; P = .0007) and 3.48 (95% CI, 1.06-13.39; P = .0488), respectively. The multivariate HR of aneurysm size for neurological morbidity after PED implantation was 1.11 (95% CI, 1.04-1.18; P = .0015), and HRs of ruptured aneurysm and age for neurological mortality were 8.1 (95% CI, 1.31-41.26; P = .0197) and 1.07 (95% CI, 1.02-1.15; P = .0262), respectively. Basilar artery aneurysm had an HR of 3.54 (95% CI, 1.12-14.18, P = .0529) in the univariate analysis for major outcomes. CONCLUSION PED implantation may be considered for the treatment of posterior circulation aneurysms, especially of saccular or dissecting type. Our major complications appear to be comparable to those reported previously after clipping and coiling in the literature. Neurointerventionists should consider the shape, size, rupture, and location of complex posterior circulation aneurysms as well as age and PED number before the PED placement.

Experience With the Pipeline Embolization Device for Posterior Circulations Aneurysms: A Multicenter Cohort Study

Neurosurgery ◽  
2020 ◽  
Author(s):  
Christoph J Griessenauer ◽  
Alejandro Enriquez-Marulanda ◽  
Philipp Taussky ◽  
Arundhati Biswas ◽  
Ramesh Grandhi ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Functional Outcome ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Posterior Circulation ◽  
Neurologic Complication ◽  
Multicenter Cohort Study ◽  
Pipeline Embolization Device ◽  
Basilar Arteries ◽  
Posterior Circulation Aneurysms ◽  
Aneurysm Occlusion

Abstract BACKGROUND The Pipeline Embolization Device (PED; Medtronic) has been used off-label for the treatment of challenging posterior circulation aneurysms. Data on this modality are primarily limited to small retrospective single-center series. OBJECTIVE To assess safety and efficacy of this treatment by establishing an international, multicenter collaboration. METHODS Consecutive posterior circulation aneurysms treated with the PED from 2012 to 2019 across 11 neurovascular centers were retrospectively reviewed. Baseline demographics, aneurysm and treatment characteristics, complications, occlusion status, and functional outcome were assessed. RESULTS There were 149 posterior circulation aneurysms treated with PED in 146 patients. A total of 24 (16.4%) patients presented with subarachnoid hemorrhage. Most aneurysms were dissecting/blister (36.2%) in morphology, followed by saccular (35.6%) and fusiform (28.2%). The most common locations were the vertebral (51.7%) and basilar arteries (22.8%). Complete or near-complete occlusion (>90%) was achieved in 90.9% of aneurysms at a median follow-up of 12 mo. Dissecting/blister aneurysms were most likely to occlude (P = .06). Symptomatic neurologic complications occurred in 9.4% of aneurysms, associated with larger size, ruptured presentation, presentations with brain stem compression, cranial nerve palsy, or stroke. Favorable functional outcome (modified Rankin Score 0-2) was achieved in 86.2% of patients. There were 6 fatalities of which 4 occurred in aneurysmal subarachnoid hemorrhage patients. CONCLUSION This multicenter study shows that PED for the treatment of posterior circulation is preferentially used for the treatment of fusiform and dissecting/blister aneurysm morphologies. Despite the challenges presented by these less-common morphologies, flow diversion may be performed with a neurologic complication rate of about 10% and favorable long-term aneurysm occlusion rates.

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