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P-003 Endovascular Concurrent Use of Coils and Pipeline Embolization Device for Intracranial Aneurysms: Clinical and Angiographic Results
  1. E Nossek,
  2. D Chalif,
  3. K Lombardo,
  4. A Setton
  1. Neurosurgery, North-Shore LIJ Health System, Manhasset, NY, USA

Abstract

Background The utility of the pipeline embolization device (PED) has been described as the sole device for treatment of brain aneurysms. The benefit using concurrent coils with limited number of PEDs is not well documented. We describe our experience with this technique as well as our mid-term clinical and angiographic results.

Methods This is a retrospective review of patients treated for brain aneurysms between 2011–2014. In this cohort, 1–3 PEDs were deployed with the addition of coils using a “jailed” microcatheter technique. A partially dense coil mass was the goal, without complete neck occlusion. Technical difficulties were reviewed. Immediate clinical and angiographic results were obtained as well as mid-term and long-term clinical outcome and aneurysms occlusion rate. Once a patient demonstrated complete occlusion on contrast MRA, Plavix was discontinued.

Results We have treated 26 patients using this technique. Median Age was 50.5 (range 31–78). The following aneurysms were treated: 1 Cavernous aneurysm; 17 proximal supraclinoid carotid, 3 posterior communicating artery aneurysms, 2 anterior choroidal artery aneurysms, 1 ICA bifurcation aneurysms and 2 intradural vertebral aneurysm. All underwent early post procedure clinical follow up.

There were no intra-procedural or post-procedural complications. All PEDs were successfully deployed. No early or delayed neurological nor neuro-ophthalmological deficits were encountered. No adverse effects due to the coil mass were observed. There were no clinical and radiographic signs of ischemia in this group. Steroids treatment was tapered quickly and discontinued within 5 days, without prolong severe headaches. During the imaging follow up, all patients demonstrated complete occlusion on the first MRA (3–5 month). Follow DSA angiography (6–9 month) confirmed complete occlusion without in-stent stenosis. All patients maintained their baseline clinical status.

Conclusions We found that the deployment of limited PEDs with concurrent partially-dense coil embolization is safe and effective. This technique achieved early complete occlusion without inducing mass effect. Favorable clinical results were observed in all patients without prolong headaches.

Disclosures E. Nossek: None. D. Chalif: None. K. Lombardo: None. A. Setton: None.

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