scholarly journals Neck Location on the Outer Convexity is a Predictor of Incomplete Occlusion in Treatment with the Pipeline Embolization Device: Clinical and Angiographic Outcomes

2020 ◽  
Vol 42 (1) ◽  
pp. 119-125
Author(s):  
T. Sunohara ◽  
H. Imamura ◽  
M. Goto ◽  
R. Fukumitsu ◽  
S. Matsumoto ◽  
...  
Keyword(s):  
Pipeline Embolization Device ◽  
Incomplete Occlusion

Reduced Efficacy of the Pipeline Embolization Device in the Treatment of Posterior Communicating Region Aneurysms with Fetal Posterior Cerebral Artery Configuration

Neurosurgery ◽  
2017 ◽  
Vol 82 (5) ◽  
pp. 695-700 ◽  
Author(s):  
Anil K Roy ◽  
Brian M Howard ◽  
Diogo C Haussen ◽  
Joshua W Osbun ◽  
Sameer H Halani ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Clinical Symptoms ◽  
Posterior Cerebral Artery ◽  
Neurological Complications ◽  
Class I ◽  
Class Iii ◽  
Pipeline Embolization Device ◽  
Independent Association ◽  
Incomplete Occlusion

Abstract BACKGROUND Aneurysms at the origin of the posterior communicating artery (PcommA) have been demonstrated to be effectively treated with the pipeline embolization device (PED). Much less is known about the efficacy of the PED for aneurysms associated with a fetal posterior cerebral artery (fPCA) variant. OBJECTIVE To study PED treatment efficacy of PcommA aneurysms, including fPCA aneurysms. METHODS A prospectively maintained university database of aneurysm patients treated with the PED was retrospectively reviewed. Demographics, treatment details, and imaging were reviewed for all PcommA and fPCA aneurysms. RESULTS Out of a total of 285 patients treated with PED, 50 patients (mean age 57.5 ± 12.2 yr, 42 females) with unruptured PcommA (9 fPCA) aneurysms were identified. Mean follow-up duration was 14.0 ± 11.6 mo (48 patients). Roy-Raymond class I occlusion on follow-up magnetic resonance or catheter angiography (mean time 11.7 ± 6.8 mo) was achieved in 30 patients (62.5%), class II occlusion in 11 patients (22.9%) and class III occlusion in 7 patients (14.5%). The PcommA was occluded in 56% of patients without any clinical symptoms. No deaths or permanent neurological complications occurred. In fPCA aneurysms, class I occlusion was seen in 1 patient, class 2 occlusion in 2 patients, and class III occlusion in 6 patients. Multivariate analysis revealed an independent association between incomplete occlusion and fPCA configuration (OR 73.65; 95% CI: 5.84-929.13; P = .001). CONCLUSION The PED is a safe and effective treatment for PcommA aneurysms, although fetal anatomy should increase consideration of traditional endovascular techniques or surgical clipping.

Predictive factors of incomplete aneurysm occlusion after endovascular treatment with the Pipeline embolization device

2020 ◽  
Vol 132 (5) ◽  
pp. 1598-1605 ◽  
Author(s):  
Georgios A. Maragkos ◽  
Luis C. Ascanio ◽  
Mohamed M. Salem ◽  
Sricharan Gopakumar ◽  
Santiago Gomez-Paz ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Predictive Factors ◽  
Cohort Analysis ◽  
Multivariable Analysis ◽  
Pipeline Embolization Device ◽  
Unruptured Aneurysms ◽  
Maximal Diameter ◽  
Aneurysm Occlusion ◽  
Incomplete Occlusion

OBJECTIVEThe Pipeline embolization device (PED) is a routine choice for the endovascular treatment of select intracranial aneurysms. Its success is based on the high rates of aneurysm occlusion, followed by near-zero recanalization probability once occlusion has occurred. Therefore, identification of patient factors predictive of incomplete occlusion on the last angiographic follow-up is critical to its success.METHODSA multicenter retrospective cohort analysis was conducted on consecutive patients treated with a PED for unruptured aneurysms in 3 academic institutions in the US. Patients with angiographic follow-up were selected to identify the factors associated with incomplete occlusion.RESULTSAmong all 3 participating institutions a total of 523 PED placement procedures were identified. There were 284 procedures for 316 aneurysms, which had radiographic follow-up and were included in this analysis (median age 58 years; female-to-male ratio 4.2:1). Complete occlusion (100% occlusion) was noted in 76.6% of aneurysms, whereas incomplete occlusion (≤ 99% occlusion) at last follow-up was identified in 23.4%. After accounting for factor collinearity and confounding, multivariable analysis identified older age (> 70 years; OR 4.46, 95% CI 2.30–8.65, p < 0.001); higher maximal diameter (≥ 15 mm; OR 3.29, 95% CI 1.43–7.55, p = 0.005); and fusiform morphology (OR 2.89, 95% CI 1.06–7.85, p = 0.038) to be independently associated with higher rates of incomplete occlusion at last follow-up. Thromboembolic complications were noted in 1.4% and hemorrhagic complications were found in 0.7% of procedures.CONCLUSIONSIncomplete aneurysm occlusion following placement of a PED was independently associated with age > 70 years, aneurysm diameter ≥ 15 mm, and fusiform morphology. Such predictive factors can be used to guide individualized treatment selection and counseling in patients undergoing cerebrovascular neurosurgery.

scholarly journals Predictors of Peri-Ophthalmic Aneurysm Incomplete Occlusion and Visual Symptoms After Treatment with a Pipeline Embolization Device: A Multi-Center Cohort Study

2021 ◽  
Author(s):  
CHAO XU ◽  
PEI WU ◽  
BOWEN SUN ◽  
SHANCAI XU ◽  
BIN LUO ◽  
...  
Keyword(s):  
Type B ◽  
Pipeline Embolization Device ◽  
Aneurysm Neck ◽  
Visual Symptoms ◽  
Post Market ◽  
Occlusion Rate ◽  
Ophthalmic Segment Aneurysms ◽  
Incomplete Occlusion ◽  
The Relationship

Abstract Objective: Peri-ophthalmic aneurysm is a special type of aneurysm. We assessed the relationship between ophthalmic artery (OA) origin and aneurysm and examined the effect of a pipeline embolization device (PED, Covidien/Medtronic) with or without coils on aneurysm occlusion rate and visual outcomes.Methods: We retrospectively analyzed 194 peri-ophthalmic aneurysms in 189 patients among 1,171 patients treated with a PED in a Chinese post-market multi-center registry study from November 2014 to October 2019. Peri-ophthalmic aneurysms were defined as carotid–ophthalmic segment aneurysms arising from the internal carotid artery dorsal wall at, or distal to, the OA origin, with a superior or superomedial projection. The relationship between OA origin and the aneurysm was classified as follows: Type A, OA originating separate from the aneurysm; Type B, OA originating from the aneurysm neck or dome. Patients with aneurysm were divided into the PED-only group and the PED + coils group according to treatment. Results: The median follow-up time was 6.8 months (range, 5.3–20.2 months). There were 163 occluded aneurysms (84%) and 31 aneurysms with incomplete occlusion (16%). A multivariate analysis showed that Type B aneurysm was a risk factor for incomplete occlusion in the PED-only group (odds ratio [OR] 4.951, 95% confidence interval [CI] 1.904-12.875, p = 0.001). Visual symptoms at final follow up correlated with preoperative visual symptoms (OR 16.005, 95% CI 2.505-102.273, p = 0.003).Conclusions: Type B aneurysm is associated with a lower occlusion rate after PED-only treatment. Patients with preoperative visual symptoms should be treated promptly to avoid permanent visual symptoms.

scholarly journals Patency of the posterior communicating artery following treatment with the Pipeline Embolization Device

2017 ◽  
Vol 126 (2) ◽  
pp. 564-569 ◽  
Author(s):  
Badih Daou ◽  
Edison P. Valle-Giler ◽  
Nohra Chalouhi ◽  
Robert M. Starke ◽  
Stavropoula Tjoumakaris ◽  
...  
Keyword(s):  
Multivariate Analyses ◽  
Univariate Analysis ◽  
Cerebral Aneurysms ◽  
Posterior Communicating Artery ◽  
Pipeline Embolization Device ◽  
Factors Associated ◽  
Previously Treated ◽  
Flow Through ◽  
Incomplete Occlusion

OBJECTIVE The Pipeline Embolization Device (PED) has become an effective treatment strategy for some cerebral aneurysms. Concerns regarding the patency of branch arteries have been raised. The objective of this study was to assess the patency of the posterior communicating artery (PCoA) following treatment of PCoA aneurysms using the PED. METHODS All patients with PCoA aneurysms treated with the PED who had angiographic follow-up were retrospectively identified. The patency of the PCoA at follow-up was evaluated by 2 authors who were not involved in the intervention. Univariate and multivariate analyses were performed to identify factors associated with the following: 1) PCoA patency versus no or diminished flow, and 2) PCoA patency and diminished flow versus PCoA occlusion. RESULTS Thirty patients with an angiographic follow-up of 6 months were included. Aneurysm obliteration was achieved in 25 patients (83.3%). The PCoA was patent in 7 patients (23.3%), had diminished flow in 7 patients (23.3%), and was occluded in 16 patients (53.3%). In the univariate analysis of outcome, there was a trend for aneurysms with incomplete occlusion, aneurysms not previously treated, those with presence of a fetal PCoA, and those with an artery coming from the aneurysm to have higher odds of the PCoA remaining patent. In univariate and multivariate analyses of factors associated with outcome, fetal PCoA and presence of an artery coming from the aneurysm were associated with the PCoA remaining open with or without diminished flow. No patients had symptoms related to PCoA occlusion. CONCLUSIONS Occlusion and diminished flow through the PCoA is common following PED treatment of PCoA aneurysms. However, it is clinically insignificant in most cases.

Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series

2015 ◽  
Vol 8 (7) ◽  
pp. 722-728 ◽  
Author(s):  
Grzegorz Brzezicki ◽  
Dennis J Rivet ◽  
John Reavey-Cantwell
Keyword(s):  
Skull Base ◽  
Treatment Option ◽  
Case Series ◽  
Endovascular Intervention ◽  
Long Term Results ◽  
Complete Revascularization ◽  
Intraoperative Complication ◽  
Pipeline Embolization Device ◽  
High Cervical

BackgroundMost cervical dissections are treated with anticoagulation or antiplatelet agents with very good results; however, some patients may benefit from endovascular intervention. High cervical and skull base dissections are often more challenging to treat because of the distal location and tortuous anatomy. The Pipeline Embolization Device (PED) may be a reasonable treatment option for this indication.ObjectivesTo report a case series of patients treated with the PED for high cervical and skull base dissections, focusing on their presentation, indications for treatment, dissection revascularization success, and pseudoaneurysm obliteration evaluated by imaging, and to review available pertinent literature.MethodsWe retrospectively reviewed all cases of high cervical and skull base dissections treated with a PED at our institution. Patient clinical characteristics, presentation, procedural and follow-up imaging, and clinical course were analyzed to evaluate for procedure complications, dissection revascularization success, pseudoaneurysm obliteration, and clinical outcome.ResultsThis is a retrospective case series including 11 patients with 13 carotid dissections treated in our center. There were nine traumatic and four spontaneous dissections. The most common presentation was cerebrovascular accident/transient ischemic attack (CVA/TIA; 5 patients) and headache/face pain (4 patients). Eleven dissections were associated with pseudoaneurysms. Three patients failed medical management with anticoagulation, although flow-limiting stenosis was the main indication for endovascular intervention. Up to three PEDs per vessel were deployed. Angioplasty was used in 10 cases. Complete revascularization (<10% residual stenosis) was achieved in 91% of vessels and 50% of pseudoaneurysms were completely or near completely obliterated immediately after PED(s) deployment. Proximal iatrogenic dissection was the only intraoperative complication. Follow-up imaging was available for nine treated vessels and demonstrated patent PEDs without significant in-stent stenosis up to 9 months after intervention. 75% of pseudoaneurysms were completely obliterated at follow-up. One PED partially collapsed but had no neurological consequences. There were no new CVA/TIAs.ConclusionsOur initial experience with treatment of high cervical and skull base dissections with the PED appears to show that this technique may be a safe and viable treatment option. However, long-term results are needed to fully evaluate the efficacy of such treatment.

E-002 Efficacy of the Pipeline Embolization Device in the Treatment of Previously-treated Aneurysms

2014 ◽  
Vol 6 (Suppl 1) ◽  
pp. A38.2-A38
Author(s):  
M Park ◽  
M Nanaszko ◽  
M Sanborn ◽  
K Moon ◽  
C McDougall ◽  
...  
Keyword(s):  
Pipeline Embolization Device ◽  
Previously Treated

Pipeline Embolization Device Versus Stent-Assisted Coiling for Intracranial Aneurysm Treatment: A Retrospective Propensity Score-Matched Study

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S17-S17
Author(s):  
Mohamed M Salem ◽  
Krishnan Ravindran ◽  
Alejandro Enriquez-Marulanda ◽  
Luis C Ascanio ◽  
Noah Jordan ◽  
...  
Keyword(s):  
Propensity Score ◽  
Intracranial Aneurysm ◽  
Pipeline Embolization Device ◽  
Aneurysm Treatment ◽  
Matched Study
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