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Original research
Silent ischemic events after Pipeline embolization device: a prospective evaluation with MR diffusion-weighted imaging
  1. Leonardo B C Brasiliense1,
  2. Morgan A Stanley2,
  3. Sanjeet S Grewal2,
  4. Harry J Cloft3,
  5. Eric Sauvageau4,
  6. Giuseppe Lanzino5,
  7. David Miller3,
  8. David F Kallmes3,
  9. Ricardo Hanel1
  1. 1Stroke and Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
  2. 2Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
  3. 3Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Department of Lyerly Neurosurgery, Baptist Health, Jacksonville, Florida, USA
  5. 5Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Ricardo Hanel, Stroke amd Cerebrovascular Center, Baptist Medical Center Jacksonville, 800 Prudential Dr, Tower B 11th Floor, Jacksonville, FL 32227, USA; rhanel{at}


Background The development of ischemic events is relatively common after endovascular interventions, and flow diverters may pose a particular threat owing to their increased technical complexity and high metal content.

Objective To investigate the incidence and potential risk factors for thromboembolic lesions after treatment with a Pipeline embolization device (PED).

Methods This prospective study included a total of 59 patients electively treated with a PED over 12 months. Postprocedural diffusion-weighted imaging sequences of the brain were obtained 24 h after interventions to detect ischemic lesions. Demographic data, aneurysm characteristics, antiplatelet management, and perioperative data were correlated with the rate of ischemic events.

Results The incidence of silent ischemic events after use of a PED was 62.7% (37 patients) and neurological symptoms occurred in 8.1% of affected patients. Development of ischemic events was significantly associated with older patients (≥60 years; p=0.038). Routine use of platelet function assays and newer P2Y12 receptor inhibitors (ticagrelor) were not associated with fewer thromboembolic events.

Conclusions Thromboembolic events are relatively common after treatment with a PED with an incidence comparable to stent-assisted and conventional coiling but the risk of neurological morbidity from ischemic burden is low. Older patients are at particularly increased risk of thromboembolic events.

  • Stroke
  • Thrombectomy

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  • Contributors All authors contributed to production and revision of this article, and gave their final approval for its submission to this journal.

  • Competing interests RH is a consultant for Covidien, Stryker, and Codman.

  • Provenance and peer review Not commissioned; externally peer reviewed.