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Treatment of recurrent intracranial aneurysms with the Pipeline Embolization Device
  1. Nohra Chalouhi,
  2. Rohan Chitale,
  3. Robert M Starke,
  4. Pascal Jabbour,
  5. Stavropoula Tjoumakaris,
  6. Aaron S Dumont,
  7. Robert H Rosenwasser,
  8. L Fernando Gonzalez
  1. Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr L Fernando Gonzalez, Department of Neurological Surgery, Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University Hospital, 901 Walnut Street, 3rd Floor, Philadelphia, PA 19107, USA; fernando.gonzalez{at}jefferson.edu

Abstract

Background The treatment of recurrent aneurysms after previous surgery or embolization is challenging. Little is known regarding the use of the Pipeline Embolization Device (PED) for recurrent aneurysms.

Objective To analyze the safety and results of PED therapy for recurrent aneurysms.

Methods Fifteen patients with recurrent intracranial aneurysms after previous embolization or surgical clipping were treated with the PED at our institution between 2011 and 2012. Procedural complications and clinical and angiographic outcomes were analyzed.

Results Median aneurysm size was 12 mm. Previous aneurysm treatment consisted of coiling in eight patients, stent coiling in four, a telescoping stent technique in two and surgical clipping in one. Major procedural complications (leaving significant morbidity) occurred in one patient (6.7%) and minor procedural or technical complications (no or minor morbidity) occurred in four patients (26.7%). Fourteen of the 15 patients (93.3%) had a favorable outcome (modified Rankin Scale score 0–2). Of 14 patients with angiographic follow-up, nine (64.3%) had complete aneurysm occlusion (100%), four (28.6%) had near-complete occlusion (≥90%) and only one (7.1%) had incomplete occlusion (<90%). Four of the five patients with less than 100% occlusion at follow-up had a previous stent in situ.

Conclusions Treatment of recurrent aneurysms with the PED appears to be effective, but patients with a previous stent in situ may achieve lower obliteration rates. The morbidity rate associated with PED therapy may be higher than with more standard endovascular techniques using historical data. Larger studies are needed to assess this question better.

  • Aneurysm

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