scholarly journals Safety and Efficacy of the Pipeline Embolization Device Use in the Outside Circle of Willis Located Intracranial Aneurysms: A Single-Center Experience

2019 ◽  
Vol 8 (2-6) ◽  
pp. 83-91 ◽  
Author(s):  
Sami Al Kasab ◽  
Waldo R. Guerrero ◽  
Daichi Nakagawa ◽  
Edgar A. Samaniego ◽  
Santiago Ortega-Gutierrez ◽  
...  
Keyword(s):  
Platelet Function ◽  
Intraoperative Complications ◽  
Circle Of Willis ◽  
Pipeline Embolization Device ◽  
Single Center Experience ◽  
The Us ◽  
Procedural Complications ◽  
Significant Disability ◽  
Device Use

Background: The use of Pipeline Embolization Device (PED) is approved by the US Food and Drug Administration (FDA) to treat aneurysms located between the petrous and superior hypophyseal segments of the internal carotid artery. The purpose of this study is to evaluate the feasibility and efficacy of treating aneurysms outside the FDA approved anatomical locations. Furthermore, we analyze the safety of our antiplatelet protocol. Methods: Data on all patients treated with PED at our center from March 2015 to December 2017 were reviewed. Only patients with aneurysms treated with PED as off label use were included. Procedural complications and long-term functional outcome measured by modified Rankin Scale (mRS) were recorded. Tirofiban maintenance infusion was administered intravenously after PED deployment. None of the patients had platelet function testing. Results: A total of 36 patients harboring 36 aneurysms were included in the study. Mean age was 58.2 years ±14.6. Nineteen were women (52.8%) and most aneurysms were unruptured (80.6%). There were no intraoperative complications. Five patients experienced postoperative complications – 4 ischemic strokes and one groin hematoma. None led to any significant disability at follow-up. Thirty-one patients (86.1%) achieved an mRS of 0–2 at follow-up. A Raymond-Roy classification of 1 was achieved in 78.9% of patients. Conclusion: The use of PED to treat aneurysms located outside the circle of Willis is feasible and effective. Our novel antiplatelet protocol did not require platelet function assay testing and did not lead to a higher rate of thrombo-embolic events compared to what has been previously reported.

Abstract 2219: Trevo System: Single Center Experience With A Novel Mechanical Thrombectomy Device

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nuno M Mendonça ◽  
Alan Flores ◽  
Jorge Pagola ◽  
Marta Rubiera ◽  
David Rodríguez-Luna ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Median Number ◽  
Single Center Experience ◽  
Procedural Complications ◽  
Thrombectomy Device ◽  
Number Of Passes

Background and Purpose: Recent reports have indicated that mechanical thrombectomy may have potential as a treatment for acute ischemic stroke. This study aims to describe the safety and effectiveness of Trevo RetrieverTM (Concentric Medical Inc, Mountain View, California) using StentrieverTM technology, in revascularization of patients with acute ischemic stroke. Methods: Prospective study evaluating the clinical, radiological and functional outcome of 13 patients with an angiographically verified occlusion of the anterior cerebral circulation. All patients underwent thrombectomy with TR as monotherapy or in combination with intra-arterial thrombolysis, within the first 8 hours from symptoms onset. Successful revascularization was defined as thrombolysis in cerebral ischemia grade 2a to 3. Good outcome was defined as modified Rankin Scale score ≤ 2. Results: Median baseline NIHSS score was 19 (16-22). The occlusion site was MCA in 8 patients and ICA in 5 patients. Five patients received IV tPA before endovascular procedure. Revascularization was achieved in 10 of 13 patients (77%). The median number of passes for maximal recanalization was 2 (1-3) and the mean time from groin puncture to recanalization was 95±31 minutes. No significant intra-procedural complications occurred. Four patients (30%) died during the 90-day follow-up period and 4 patients (30%) achieved functional independence at 3 months. Conclusions: Early clinical experience suggests that the TR can allow safe and effective revascularization in certain subjects with acute ischemic stroke.

scholarly journals Pipeline Embolization Device for the Treatment of Unruptured Intracranial Dissecting Aneurysms

2021 ◽  
Vol 12 ◽  
Author(s):  
Jigang Chen ◽  
Mushun Tao ◽  
Jiangli Han ◽  
Xin Feng ◽  
Fei Peng ◽  
...  
Keyword(s):  
Artery Occlusion ◽  
Effective Treatment Option ◽  
Pipeline Embolization Device ◽  
Hemorrhagic Events ◽  
Procedural Complications ◽  
Aneurysm Occlusion ◽  
Late Thrombosis ◽  
Favorable Clinical Outcome ◽  
Dissecting Aneurysms

Background: Intracranial dissecting aneurysms (IDAs) are rare but pose significant challenges to treatment. The pipeline embolization device (PED) has been demonstrated to be an effective treatment option with excellent outcomes. Herein, we report our experience with patients treated with the PED for unruptured IDAs.Methods: We retrospectively reviewed our hospital database and identified patients who were treated with PEDs for unruptured IDAs between March 2016 and September 2020. Data including demographics, clinical presentation, aneurysm characteristics, procedural details, intra- or peri-procedural complications, and follow-up details were collected.Results: Eighty patients (61 men, 76.25%) were treated with PED for unruptured IDAs. The most common symptoms were headache (34, 42.5%), dizziness (29, 36.25%), and nausea or vomiting (15, 18.75%). Of these patients, 73 had one aneurysm, and seven harbored two aneurysms. All of them achieved successful PED deployment. Six patients experienced intra- or peri-procedural complications including perforator artery occlusion, thromboembolic, hemorrhagic events, and falling of the stent into the aneurysm sac. Follow-up with digital subtractive angiography was available for 29 patients with a median of 6 months, and 28 (96.56%) patients had aneurysm occlusion. Late thrombosis occurred in four patients, and two of them had unfavorable outcomes. Clinical follow-up showed that a favorable clinical outcome was achieved in 76 (95%) patients, and the mortality rate was 3.75%.Conclusion: Treating unruptured IDAs is safe and effective with long-term favorable clinical and angiographic outcomes. However, the complications of this treatment should be noted. Careful selection of appropriate patients and individualized antiplatelet therapy might be needed.

scholarly journals Anterior Communicating Artery Aneurysm Treatment with the Pipeline Embolization Device: A Single-Center Experience with Long-Term Follow-Up

2017 ◽  
Vol 6 (3-4) ◽  
pp. 126-134 ◽  
Author(s):  
Ali Sultan-Qurraie ◽  
Ahsan Sattar ◽  
Wled Wazni ◽  
Mazen Noufal ◽  
Osama Zaidat
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Data Set ◽  
Pipeline Embolization Device ◽  
Aneurysm Neck ◽  
Single Center Experience

Introduction: The pipeline embolization device (PED) is increasingly used in the endovascular management of cerebral aneurysms. Longitudinal data regarding safety and benefit of the PED in anterior communicating (ACOM) artery aneurysms are limited and particularly lacking in residual ACOM artery aneurysms. We report the use of the PED in 3 patients with ACOM artery aneurysms who were previously coiled. Methods: Three patients with ACOM artery aneurysms, all previously treated with coiling and with recurrence of the aneurysm neck, were treated with the PED. All obtained follow-up diagnostic cerebral angiograms at either 3 or 6 months. Results: Mean age of patients was 59 years. All patients received cerebral angiograms at a minimum of 3 months after treatment with the PED. Follow-up angiography was performed up to a mean of 10 months at which time point all cases demonstrated complete aneurysm occlusion, without any stenosis in the parent artery. Conclusion: The PED can be safely used for the treatment of ACOM artery aneurysms. Complete aneurysm obliteration can be achieved in cases refractory to endovascular coiling. These findings warrant replication in a larger data set.

scholarly journals Endovascular treatment of medium and large intracranial aneurysms with large volume coils: A single-center experience

2022 ◽  
Vol 13 ◽  
pp. 9
Author(s):  
Giancarlo Saal-Zapata ◽  
Basavaraj Ghodke ◽  
Melanie Walker ◽  
Ivethe Pregúntegui-Loayza ◽  
Rodolfo Rodríguez-Varela
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Large Volume ◽  
Intracranial Aneurysms ◽  
Intraoperative Complications ◽  
Complication Rates ◽  
Single Center ◽  
Single Center Experience ◽  
The Mean

Background: Large volume coils are an alternative to conventional coils for the treatment of intracranial aneurysms. However, there are no published reports documenting occlusion and complication rates in medium and large intracranial aneurysms. Therefore, we present our results in this subgroup of aneurysms. Methods: A single-center, retrospective analysis of consecutive patients treated with Penumbra coils 400 in aneurysms ≥7 mm was performed. Demographics, aneurysm features, procedural details, intraoperative complications, clinical outcomes, and occlusion rates were analyzed. Results: Thirty-three patients were included for analysis, and a total of 33 intracranial aneurysms were analyzed. Mean age was 57.6 years (SD ± 12.4) and 85% of the patients were women. Large aneurysms represented 46% of cases. Paraclinoid (55%) followed by posterior communicating (30.3%) aneurysms was the most frequently treated. Ruptured and saccular aneurysms were found in 49% and 63% of the cases, respectively. The mean aneurysmal dimensions were 14.2 mm width, 11.9 mm length, 5.4 mm neck, and 2.4 dome-to-neck ratio. A dome-neck ratio <2 was identified in 39% of cases. The mean number of coils per aneurysm was 4.8. Immediate modified Raymond–Roy Grades 1, 2, and 3A were achieved in 15%, 21%, and 64%, respectively. Twenty-six patients were evaluated at a mean follow-up period of 11 months, with an adequate occlusion of 92% and a good clinical outcome (modified Rankin score ≤2) in 96% of patients. Conclusion: Endovascular treatment with PC400 coils is an effective and safe option for medium and large intracranial aneurysms with high occlusion rates, few complications, and good clinical outcomes at follow-up.

Treatment of Posterior Circulation Aneurysms With the Pipeline Embolization Device

Neurosurgery ◽  
2013 ◽  
Vol 72 (6) ◽  
pp. 833-889 ◽  
Author(s):  
Nohra Chalouhi ◽  
Stavropoula Tjoumakaris ◽  
Aaron S. Dumont ◽  
L. Fernando Gonzalez ◽  
Ciro Randazzo ◽  
...  
Keyword(s):  
Posterior Circulation ◽  
Patient Treatment ◽  
Pipeline Embolization Device ◽  
Unruptured Aneurysms ◽  
Aneurysm Size ◽  
Procedural Complications ◽  
Posterior Circulation Aneurysms ◽  
Vertebrobasilar Junction ◽  
Aneurysm Occlusion

Abstract BACKGROUND: Treatment of complex intracranial aneurysms with the pipeline embolization device (PED) has become common practice in neurovascular centers. Very few studies have assessed the safety and efficacy of PED treatment for posterior circulation aneurysms. OBJECTIVE: To retrospectively present our experience with use of the PED in the posterior circulation. METHODS: A total of 7 patients harboring 7 posterior circulation aneurysms were treated with the PED at our institution between November 2011 and July 2012. RESULTS: Aneurysm size was 14.1 mm on average. All patients had unruptured aneurysms. Three aneurysms arose from the vertebral artery, 2 from the basilar artery, and 2 from the vertebrobasilar junction. A single stent was used in 4 patients, 2 stents in 2 patients, and 3 stents in 1 patient. Treatment was successful in all 7 patients. No procedural complications or perforator infarcts were noted in the series. No patient experienced new neurological symptoms related to PED treatment during the follow-up period. Angiographic follow-up was available for 6 patients at a mean time point of 5.5 months. Follow-up angiography showed 100% aneurysm occlusion in 3 patients, marked decrease in aneurysm size in 2 patients, and no change in 1 patient. CONCLUSION: In our initial experience, it appears that PED treatment in select patients with vertebrobasilar aneurysms may have a reasonable safety-efficacy profile. Larger studies are needed to confirm our findings.

Abstract WMP29: Single-Center Experience with The Pipeline Embolization Device: The Treatment of Smaller Secondary Aneurysms

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Ratul Raychaudhuri ◽  
Inam Kureshi ◽  
Martin Ollenschleger ◽  
Stephen Ohki ◽  
Gary Spiegel
Keyword(s):  
Single Case ◽  
Endovascular Coiling ◽  
Limited Information ◽  
Single Center ◽  
Pipeline Embolization Device ◽  
Single Center Experience ◽  
Aneurysm Occlusion ◽  
The Impact ◽  
Wide Neck

The Pipeline embolization device is a flow diverting stent that is now available as an FDA approved treatment for giant wide-neck cavernous and supraclinoid aneurysms. This revolutionary device has made it possible to safely treat large wide necked aneurysms with excellent results. There is limited information on the impact of Pipeline on smaller secondary aneurysms. We present single center data regarding Pipeline’s efficacy in the treatment of these aneurysms. Methods: Since August 2012, 24 patients have been electively treated utilizing the Pipeline Embolization Device (PED) (Covidien, Mansfield, MA) at Hartford Hospital. Of these patients, 17 patients have had follow up angiograms and 9 (52%) had smaller secondary aneurysms that was covered by the Pipeline stent. For each patient where angiographic follow-up was available, the degree of secondary aneurysm occlusion was assessed utilizing the Raymond criteria. Results: All procedures were successfully completed and a total of 41 PEDS were implanted. No intraprocedural complications were present. During the clinical follow-up period, no major complications resulted. One patient developed a partial CN III and IV neuropathy secondary to thrombosis of a large cavernous aneurysm 4 days following treatment. The results of 6 month follow-up angiography demonstrated that out of a total of 9 cases, 8 cases (89%) with smaller secondary aneurysms resolved and 1 case (11%) improved significantly. In all cases where the smaller secondary aneurysm was occluded, the larger primary aneurysm was also occluded. The single case of significant improvement demonstrated that the primary aneurysm had also significantly decreased in size. Conclusion: Smaller secondary aneurysms are adequately treated by Pipeline stenting. In all cases, the primary aneurysm either improved significantly or totally occluded along with the secondary aneurysms. This suggests that the Pipeline device, in addition to treating large wide-necked aneurysms, can effectively treat smaller associated aneurysms without the need for additional endovascular coiling. Key Words: Pipeline embolization device, giant wide-neck cavernous and supraclinoid aneurysm, secondary aneurysms

Outcomes after surgical removal of anterior epi-capsular plaque associated with persistent pupillary membranes in children

2021 ◽  
pp. 112067212110206
Author(s):  
Massimiliano Serafino ◽  
Rupal H Trivedi ◽  
Marion Edward Wilson ◽  
Muralidhar Ramappa ◽  
Divya Sree Ramya Achanta ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Case Series ◽  
Early Period ◽  
Crystalline Lens ◽  
Surgical Removal ◽  
Age At Surgery ◽  
Device Use ◽  
Ophthalmic Viscosurgical Device

Introduction: Anteriorepi-capsular plaque (ACP) is usually eccentric and is associated with persistent iris strands arising from the collarette. Outcomes of lens preserving ACP peeling along with removal of persistent pupillary membrane (PPM) strands have seldom been reported with only a few cases within some case series appearing in the literature. Herein we aim to report outcome after surgical removal of ACP associated with PPM in children. Methods: Research was done in three different Institutes. Charts were reviewed for all children who had undergone ACP removal surgery from 2010. Age at surgery, gender, preoperative best corrected visual acuity (BCVA), preoperative refraction, morphologic details of ACP, intraoperative complications, ophthalmic viscosurgical device use, age at last follow-up, postoperative complications, and postoperative BCVA were reviewed. Results: A total of 16 patients, 10 male and 6 female, were included in study. Age at surgery ranged from 2 to 86 months old. Age at last follow up visit ranged from 2 to 14 years old. Postoperative complications were not observed in any of the 16 patients. Specifically, in all patients the crystalline lens remained clear at the last follow up visit. Conclusions: Congenital ACP of the lens associated with PPM and clear lens can be safely surgically removed with a very low risk of iatrogenic cataract in the early period after surgery.

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