Objective Evaluation of the safety and efficacy of the Pipeline embolization device (PED) when used as second-line treatment for recurrent or residual, pretreated ruptured and unruptured intracranial aneurysms (IAs).
Methods Retrospective review of our database to include all patients who were treated with a PED for recurrent or residual IAs following surgical clipping or coiling. We evaluated neurological outcome and angiograms at discharge, 6- and 12-months’ follow-up and assessed intimal hyperplasia at follow-up.
Results Twenty-four patients met our inclusion criteria. Most IAs were located in the anterior circulation (n=21). No change of preprocedure modified Rankin Scale score was seen at discharge or at any scheduled follow-up. Complete or near-complete aneurysm occlusion on 6- and 12-month angiograms was seen in 94.4% (17/18 cases) and 93.3% (14/15 cases), respectively. Complete or near-complete occlusion was seen in 100% of previously ruptured and 85.7% (6/7 cases) and 83.3% (5/6 cases) of previously unruptured cases at the 6- and 12-months’ follow-up, respectively. One case of moderate intimal hyperplasia was observed at 6 months and decreased to mild at the 12-months’ follow-up. No difference in device performance was observed among pretreated unruptured or ruptured IAs.
Conclusions Treatment of recurrent or residual IAs with a PED after previous coiling or clipping is feasible and safe. There is no difference in device performance between ruptured or unruptured IAs.
- Flow Diverter
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Contributors Study design: ALK, AKW, and ASP. Data acquisition: ALK, KdMR, JDL, AKW, DER, FM, MH, CB, JLH, and ASP. Literature research: ALK, KdMR, JDL, DER, FM, TT, and MH. Data analysis and interpretation: ALK, KdMR, MJG, AKW, and ASP. Manuscript preparation: ALK and ASP. Revision of manuscript for important intellectual content: KdMR, JDL, AKW, DER, FM, MJG, MH, CB, TT, and JLH. Approval of final version of manuscript: all authors.
Competing interests MJG is a consultant for Codman Neurovascular and Stryker Neurovascular; research grants: NIH, eV3/Covidien Neurovascular, Codman Neurovascular, Fraunhofer Institute, Wyss Institute, Philips Healthcare, Stryker Neurovascular, Silk Road, Lazarus-Effect. AKW is a consultant for Stryker Neurovascular; research grants: Philips Healthcare, Wyss Institute; speaker: Harvard Postgraduate Course, Miami Cardiovascular Institute. ASP is a consultant for Codman Neurovascular, Stryker Neurovascular, and Covidien; research grant from Stryker Neurovascular and Covidien; speaker: Miami Cardiovascular Institute.
Ethics approval Institutional review board at University of Massachusetts Medical School.
Provenance and peer review Not commissioned; externally peer reviewed.