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Utilization of Pipeline embolization device for treatment of ruptured intracranial aneurysms: US multicenter experience
  1. Ning Lin1,
  2. Adam M Brouillard1,
  3. Kiffon M Keigher2,
  4. Demetrius K Lopes2,
  5. Mandy J Binning3,
  6. Kenneth M Liebman3,
  7. Erol Veznedaroglu3,
  8. Jordan A Magarik4,
  9. J Mocco4,
  10. Edward A Duckworth5,6,
  11. Adam S Arthur5,
  12. Andrew J Ringer7,
  13. Kenneth V Snyder1,8,9,10,
  14. Elad I Levy1,9,10,
  15. Adnan H Siddiqui1,9,10,11
  1. 1Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  2. 2Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
  3. 3Department of Neurosurgery, Capital Health Stroke and Cerebrovascular Center, Trenton, New Jersey, USA
  4. 4Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  5. 5Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute University of Tennessee, Memphis, Tennessee, USA
  6. 6Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  7. 7Department of Neurosurgery, Mayfield Clinic, University of Cincinnati, Cincinnati, Ohio, USA
  8. 8Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  9. 9Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
  10. 10Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
  11. 11Jacobs Institute, Buffalo, New York, USA
  1. Correspondence to Dr A H Siddiqui, University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo NY 14203, USA; asiddiqui{at}ubns.com

Abstract

Objective Utilization of the Pipeline embolization device (PED) in complex ruptured aneurysms has not been well studied. We evaluated the safety and effectiveness data from five participating US centers.

Methods Records of patients with ruptured cerebral aneurysms who underwent PED treatment between 2011 and 2013 were retrospectively reviewed.

Results 26 patients with ruptured aneurysms underwent PED treatment (mean age 51.4±13.2 years;16 women). At presentation, 8 patients (30.8%) had a Hunt–Hess grade of IV or above; 11 required extraventricular drain placement. Aneurysm morphologies were: 8 dissecting, 8 blister-like, 6 fusiform, and 4 saccular. There were 22 anterior circulation and 4 posterior circulation aneurysms. PED deployment was successful in all patients, with adjunctive coiling utilized in 12. Periprocedural complications occurred in 5 (19.2%), including 3 inhospital deaths. 23 patients (88.5%) had postoperative angiography at a mean of 5.9 months: 18 aneurysms (78.3%) were completely occluded, 3 (13.0%) had residual neck filling, and 2 (8.7%) had residual dome filling. All blister-type aneurysms were completely occluded at follow-up. Clinical follow-up was available for an average of 10.1 months (range 2–21 months), with one asymptomatic in-stent stenosis and one asymptomatic thromboembolic stroke noted. Good outcome (modified Rankin Scale (mRS) score of 0–2) was achieved in 20 patients (76.9%), fair (mRS 3–4) in 3 (11.5%), and 3 died (11.5%).

Conclusions The PED can be utilized for ruptured aneurysms and is a good option for blister-type aneurysms. However, due to periprocedural complications, it should be reserved for lesions that are difficult to treat by conventional clipping or coiling.

  • Aneurysm
  • Hemorrhage
  • Flow Diverter

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