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  • P-021 Multi-center case series of 33 patients with ruptured internal carotid artery blister pseudoaneurysms treated with phosphorylcholine surface-modified flow diverter

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SNIS 20th annual meeting oral poster abstracts
P-021 Multi-center case series of 33 patients with ruptured internal carotid artery blister pseudoaneurysms treated with phosphorylcholine surface-modified flow diverter
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  1. M Bounajem1,
  2. E Joyce1,
  3. J Scoville1,
  4. J Seinfeld2,
  5. J Hoffman2,
  6. J Grossberg3,
  7. V Waiters4,
  8. A White5,
  9. J Nerva6,
  10. J Burkhardt7,
  11. D Tonetti8,
  12. K El Naamani9,
  13. M Gooch9,
  14. P Jabbour9,
  15. S Tjoumakaris9,
  16. S Ortega Gutierrez10,
  17. M Levitt11,
  18. M Lang12,
  19. W Ares13,
  20. S Desai14,
  21. J Mascitelli15,
  22. C Kilburg1,
  23. K Budohoski1,
  24. W Couldwell1,
  25. B Gross12,
  26. R Grandhi1
  1. 1Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
  2. 2Department of Neurosurgery, University of Colorado, Aurora, CO, USA
  3. 3Department of Neurosurgery, Emory University, Atlanta, GA, USA
  4. 4Morehouse School of Medicine, Atlanta, GA, USA
  5. 5Department of Neurosurgery, University of Texas Southwestern Medical School, Dallas, TX, USA
  6. 6Department of Neurosurgery, Medical College of Wisconsin, Miluakee, WI, USA
  7. 7University of Pennsylvania, Philadelphia, PA, USA
  8. 8Department of Neurosurgery, Cooper Medical School, Camden, NJ, USA
  9. 9Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
  10. 10Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
  11. 11Department of Neurosurgery, University of Washington, Seattle, WA, USA
  12. 12Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  13. 13Department of Neurosurgery, North Shore University Health Systems, Evanston, IL, USA
  14. 14Department of Neurosurgery, University of Texas Rio Grande Valley, Edinburg, TX, USA
  15. 15Department of Neurosurgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA

Abstract

Objective Ruptured blister, dissecting, and iatrogenic pseudoaneurysms are rare pathologies that pose significant challenges from a treatment standpoint. Endovascular treatment via flow diversion represents an increasingly popular option; however, drawbacks include the requirement for dual antiplatelet therapy and the potential for thromboembolic complications, particularly acutely in the ruptured setting. The Pipeline Flex Embolization device with Shield technology (PED-Shield) offers a reduced material thrombogenicity via coating with phosphorylcholine, which may aid in the treatment of ruptured internal carotid artery pseudoaneurysms.

Methods The authors conducted a multi-institution, retrospective case series to determine the safety and efficacy of PED-Shield in the treatment of ruptured blister, dissecting, and iatrogenic pseudoaneurysms of the internal carotid artery. Clinical, radiographic, treatment, and outcomes data were collected.

Results Thirty-three patients were included in the final analysis. Seventeen underwent placement of a single device and 16 underwent placement of two devices. Adjunctive coiling was conducted in two cases. Four patients were maintained on aspirin alone and all others were treated with long-term dual antiplatelet therapy. No thromboembolic complications occurred. Among patients with 3-month follow-up, 93.8% had an modified Rankin Scale score of 0-2. Overall complete occlusion at follow-up was observed in 82.6% of patients. Among patients treated with multiple telescoping devices, complete occlusion was observed in 90.9% of cases, while those treated with a single device demonstrated complete occlusion in 72.7% of cases. Extremely early complete occlusion (observed in less than one month post-operatively) was observed in five patients. Of the five patients, four underwent placement of multiple telescoping devices, while the remaining one was treated with a single device.

Conclusions PED-Shield represents a new option for treatment of ruptured blister, dissecting, and iatrogenic pseudoaneurysms of the internal carotid artery, and the presented work represents the largest series to date describing treatment of this pathology with PED-Shield. The reduced material thrombogenicity appears to improve the safety of the PED-Shield device, as our series demonstrated no thromboembolic complications, even among patients treated with only single antiplatelet therapy. The efficacy of the PED-Shield reported in this series, particularly with placement of two devices, demonstrates its potential as a first-line treatment option for these pathologies.

Disclosures M. Bounajem: None. E. Joyce: None. J. Scoville: None. J. Seinfeld: 2; C; Medtronic. J. Hoffman: None. J. Grossberg: 1; C; GRA, EMFC, Neurosurgery Catalyst. 4; C; Cognition. V. Waiters: None. A. White: None. J. Nerva: 4; C; Midwest Interventional Systems Inc, Synchron LLC, Bendit Technologies Ltd, Borvo Medical. J. Burkhardt: 2; C; Microvention, Cerenovus, Stryker, Medtronic, Longeviti Neuro Solutions, Q`Apel Medical. D. Tonetti: None. K. El Naamani: None. M. Gooch: 2; C; Stryker. P. Jabbour: 1; C; Medtronic. S. Tjoumakaris: 6; C; Microvention. S. Ortega Gutierrez: 6; C; Stryker, Medtronic, Microvention. M. Levitt: 1; C; Medtronic, Stryker. 2; C; Metis Innovative, Aeaean Advisers, Stereotaxis. 6; C; Prioprio, Hyperion Surgical, Synchron, Fluid Biomed, Cerebrotech. M. Lang: None. W. Ares: None. S. Desai: None. J. Mascitelli: 2; C; Stryker. C. Kilburg: 6; C; Medtronic, Cerenovus. K. Budohoski: None. W. Couldwell: None. B. Gross: 2; C; Medtronic, Microvention, Stryker. R. Grandhi: 6; C; Medtronic, Cerenovus, Balt.

https://doi.org/10.1136/jnis-2023-SNIS.93

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