Journal ArticleDOI
Predictors of cerebral aneurysm persistence and occlusion after flow diversion: a single-institution series of 445 cases with angiographic follow-up.
Matthew T. Bender,Geoffrey P. Colby,Li Mei Lin,Bowen Jiang,Erick M. Westbroek,Risheng Xu,Jessica K. Campos,Judy Huang,Rafael J. Tamargo,Alexander L. Coon +9 more
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TLDR
This is the largest single-institution study showing high rates of anterior circulation aneurysm occlusion after Pipeline embolization, and predictors of persistence after flow diversion included increasing aneurYSm size and incorporated branch vessel, whereas adjunctive coiling predicted occlusions.Abstract:
OBJECTIVE Flow diversion requires neointimal stent overgrowth to deliver aneurysm occlusion. The existing literature on aneurysm occlusion is limited by heterogeneous follow-up, variable antiplatelet regimens, noninvasive imaging modalities, and nonstandard occlusion assessment. Using a large, single-center cohort with low attrition and standardized antiplatelet tapering, the authors evaluated outcomes after flow diversion of anterior circulation aneurysms to identify predictors of occlusion and aneurysm persistence. METHODS Data from a prospective, IRB-approved database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion with the Pipeline embolization device (PED) at the authors' institution. Follow-up consisted of catheter cerebral angiography at 6 and 12 months postembolization. Clopidogrel was discontinued at 6 months and aspirin was reduced to 81 mg daily at 12 months. Occlusion was graded as complete, trace filling, entry remnant, or aneurysm filling. Multivariate logistic regression was performed to identify predictors of aneurysm persistence. RESULTS Follow-up catheter angiography studies were available for 445 (91%) of 491 PED procedures performed for anterior circulation aneurysms between August 2011 and August 2016. Three hundred eighty-seven patients accounted for these 445 lesions with follow-up angiography. The population was 84% female; mean age was 56 years and mean aneurysm size was 6.6 mm. Aneurysms arose from the internal carotid artery (83%), anterior cerebral artery (13%), and middle cerebral artery (4%). Morphology was saccular in 90% of the lesions, and 18% of the aneurysms has been previously treated. Overall, complete occlusion was achieved in 82% of cases at a mean follow-up of 14 months. Complete occlusion was achieved in 72%, 78%, and 87% at 6, 12, and 24 months, respectively. At 12 months, adjunctive coiling predicted occlusion (OR 0.260, p = 0.036), while male sex (OR 2.923, p = 0.032), aneurysm size (OR 3.584, p = 0.011), and incorporation of a branch vessel (OR 2.206, p = 0.035) predicted persistence. Notable variables that did not predict aneurysm occlusion were prior treatments, vessel of origin, fusiform morphology, and number of devices used. CONCLUSIONS This is the largest single-institution study showing high rates of anterior circulation aneurysm occlusion after Pipeline embolization. Predictors of persistence after flow diversion included increasing aneurysm size and incorporated branch vessel, whereas adjunctive coiling predicted occlusion.read more
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Journal ArticleDOI
Flow Diversion of Posterior Circulation Cerebral Aneurysms: A Single-Institution Series of 59 Cases
Matthew T. Bender,Geoffrey P. Colby,Bowen Jiang,Li Mei Lin,Jessica K. Campos,Risheng Xu,Erick M. Westbroek,Chau D. Vo,David A. Zarrin,Justin M. Caplan,Judy Huang,Rafael J. Tamargo,Alexander L. Coon +12 more
TL;DR: This is a large single-institution series of Pipeline (Medtronic Inc) for posterior circulation aneurysms and demonstrates acceptable safety and effectiveness in these challenging cases.
Journal ArticleDOI
Safety and Effectiveness of the Pipeline Flex Embolization Device With Shield Technology for the Treatment of Intracranial Aneurysms: Midterm Results From a Multicenter Study.
Felipe Padovani Trivelato,Eduardo Wajnberg,Marco Túlio Salles Rezende,Alexandre Cordeiro Ulhôa,Ronie Leo Piske,Thiago Giansante Abud,Luis Henrique de Castro-Afonso,Carlos Gustavo Coutinho Abath,Guilherme Seizem Nakiri,João Francisco Santoro Araújo,José Laércio Júnior Silva,Renato Tavares Tosello,José Ricardo Vanzin,Luciano Bambini Manzato,Carlos E. Baccin,Bruno Anderson Araújo da Mota,Daniel Giansante Abud +16 more
TL;DR: The PED Shield is a safe and effective treatment for intracranial aneurysms and long-term follow-up and comparative studies are required to provide stronger conclusions regarding the reduced thrombogenicity of this device.
Journal ArticleDOI
Expanding Indications for Flow Diverters: Distal Aneurysms, Bifurcation Aneurysms, Small Aneurysms, Previously Coiled Aneurysms and Clipped Aneurysms, and Carotid Cavernous Fistulas.
Nicola Limbucci,Giuseppe Leone,Leonardo Renieri,Sergio Nappini,Federico Cagnazzo,Antonio Laiso,Mario Muto,Salvatore Mangiafico +7 more
TL;DR: A review of the relevant literature concerning “off-label” indications for flow diverter devices, such as for distal aneurysms, bifurcation aneurYSms, small aneuryms, recurrent aneurisms, and direct carotid cavernous fistulas, finds that the use of these stents has widely grown up even if not supported by randomized studies.
Journal ArticleDOI
Predictive factors of incomplete aneurysm occlusion after endovascular treatment with the Pipeline embolization device
Georgios A Maragkos,Luis C. Ascanio,Mohamed M. Salem,Sricharan Gopakumar,Santiago Gomez-Paz,Alejandro Enriquez-Marulanda,Abhi Jain,Clemens M. Schirmer,Paul M. Foreman,Christoph J. Griessenauer,Peter Kan,Christopher S. Ogilvy,Ajith J. Thomas +12 more
TL;DR: Incomplete aneurysm occlusion following placement of a PED was independently associated with age > 70 years, aneurYSm diameter ≥ 15 mm, and fusiform morphology, and can be used to guide individualized treatment selection and counseling in patients undergoing cerebrovascular neurosurgery.
Journal ArticleDOI
Derivo Embolization Device for the Treatment of Intracranial Aneurysms.
Felipe Padovani Trivelato,Daniel Giansante Abud,Alexandre Cordeiro Ulhôa,Eduardo Siqueira Waihrich,Thiago Giansante Abud,Luís Henrique de Castro Afonso,Guilherme Seizem Nakiri,Guilherme Duarte de Castro,Bruno de Sousa Mendes Parente,Rodrigo dos Santos Silva,Luciano Bambini Manzato,Lucas Eduardo Bonadio,Dinark Conceição Viana,José Ricardo Vanzin,Carlos E. Baccin,Marco Túlio Salles Rezende +15 more
TL;DR: The BRAIDED trial as discussed by the authors evaluated the effectiveness of the Derivo Embolization Device in the treatment of intracranial aneurysms and showed that it is safe and effective in all patients.
References
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Journal ArticleDOI
Long-Term Angiographic Recurrences After Selective Endovascular Treatment of Aneurysms With Detachable Coils
Jean Raymond,François Guilbert,Alain Weill,Stavros A. Georganos,Louis Juravsky,Anick Lambert,Julie Lamoureux,Miguel Chagnon,Daniel Roy +8 more
TL;DR: Variables determined to be significant predictors of a recurrence included aneurysm size ≥10 mm, treatment during the acute phase of rupture, incomplete initial occlusions, and duration of follow-up, and long-term monitoring of patients treated by endosaccular coiling is mandatory.
Journal ArticleDOI
Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience.
Pedro Lylyk,Carlos Miranda,Rosana Ceratto,Angel Ferrario,Esteban Scrivano,Hugh Ramirez Luna,Aaron L. Berez,Quang Tran,Peter Kim Nelson,David Fiorella +9 more
TL;DR: The Pipeline Embolization Device (PED) as mentioned in this paper is a microcatheter-delivered endovascular construct designed to achieve the curative reconstruction of the parent arteries giving rise to wide-necked and fusiform intracranial aneurysms.
Journal ArticleDOI
Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial.
Tibor Becske,David F. Kallmes,Isil Saatci,Cameron G. McDougall,István Szikora,Giuseppe Lanzino,Christopher J. Moran,Henry H. Woo,Demetrius K. Lopes,Aaron L. Berez,Daniel J. Cher,Adnan H. Siddiqui,Elad I. Levy,Felipe C. Albuquerque,David Fiorella,Zsolt Berentei,Miklos G. Marosfoi,Saruhan Cekirge,Peter Kim Nelson +18 more
TL;DR: PED offers a reasonably safe and effective treatment of large or giant intracranial internal carotid artery aneurysms, demonstrated by high rates of completeAneurysm occlusion and low rates of adverse neurologic events; even in aneurYSms failing previous alternative treatments.
Pipeline for Uncoilable or Failed aneurysms: Results from a
Tibor Becske,David F. Kallmes,Isil Saatci,Cameron G. McDougall,István Szikora,Giuseppe Lanzino,Chris Moran,Henry H. Woo,Demetrius K. Lopes,Aaron L. Berez,Daniel J. Cher,Adnan H. Siddiqui,Elad I. Levy,Felipe C. Albuquerque,David Fiorella,Zsolt Berentei,Saruhan Cekirge,Peter Kim Nelson +17 more
Journal ArticleDOI
Endovascular Treatment of Intracranial Aneurysms With Flow Diverters A Meta-Analysis
TL;DR: Treatment of intracranial aneurysms with flow-diverter devices is feasible and effective with high complete occlusion rates, however, the risk of procedure-related morbidity and mortality is not negligible.
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