Purpose Retrospective review of all Medtronic Pipeline Flex flow diverting stent placement at single center with attention to guiding catheter selection, technical success, intracranial complications, access site complications and length of procedure. Summarize technical advantages and limitations of each access strategy and present a simplified 6 French triaxial system for flow diversion stent placement via a transradial/trans-ulnar approach. We also present some tips and tricks to optimize procedural success including transulnar access and direct radial access.
Materials and methods Single Center retrograde suspect of review of all Medtronic Pipeline Embolization Flex procedures performed between October 2015-March 2019 via arm access (radial or ulnar). Three different 6F constructs were used for arm access:
Direct radial access with long sheath–Terumo destination slender
Benchmark radial access
Codman Envoy DA radial access
Primary endpoints include time from radial accessed to target lesion, time from radial access to pipeline embolization deployment, technical failure requiring alternative access, intracranial complications, radial access site complications, occlusion rates at longest available follow-up were delayed neurologic complications.
Results A total of 23 patients were included in this retrospective analysis. Average patient age and male gender were 60.4 years and 22% respectively. A total of 31 devices were used to treat a total of 30 aneurysms. Average aneurysm size was 7 mm. Primary placement of a flow diverting stent was performed in a majority of patients with adjunctive coil placement was performed in 13.1% procedures. Post stent placement balloon angioplasty was performed in 34% procedures. No intracranial complications including dissection, intracranial hemorrhage, symptomatic embolic stroke were identified. Major access site complications and symptomatic delayed radial artery occlusion were not identified in any patients undergoing arm access. Furthest available follow-up was on an average of 9.8 months. Complete occlusion was achieved in 70% patients (we anticipate further occlusion by one year). Additional pipeline embolization devices were required in 1 patient, at 18 months. Foley catheter and arterial line placement, 35% and 22%, respectively.
Limitations Single center retrospective review, short interval follow-up (less than 1 year), and some patients lost to follow-up.
Conclusion 6 French Triaxial Trans-radial (or ulnar access) can be used in placement of a Pipeline Embolization Flex device with low associated complications and high technical success.
Disclosures S. Satti: 2; C; Stryker Neurovascular, Medtronic Neurovascular, Penumbra Neurovascular, Cerenovus Neurovascular, Terumo. T. Eden: None.
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