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Pipeline embolic device

Elias Atallah, Hassan Saad, Jonathan Li, Ayan Kumar, Stavropoula Tjoumakaris, Nohra Chalouhi, David Hasan, Hekmat Zarzour, Nabeel Herial, Michael Reid Gooch, Robert H Rosenwasser, Pascal Jabbour
BACKGROUND: The use of the pipeline embolization device (PED; Medtronic, Dublin, Ireland) in the posterior circulation has been limited and infrequently reported compared to other off-label utilizations. Posterior inferior cerebellar artery aneurysms (PICAA) constitute 1 of the least reported posterior circulation aneurysms treated with PED. No clinical studies have addressed the treatment of these aneurysms with flow diversion exclusively. OBJECTIVE: To appraise the feasibility and the safety of PED in the treatment of PICAAs...
February 12, 2019: Operative Neurosurgery (Hagerstown, Md.)
Jan-Karl Burkhardt, Omar Tanweer, Miguel Litao, Pankaj Sharma, Eytan Raz, Maksim Shapiro, Peter Kim Nelson, Howard A Riina
OBJECTIVEA systematic analysis on the utility of prophylactic antibiotics for neuroendovascular procedures has not been performed. At the authors' institution there is a unique setup to address this question, with some attending physicians using prophylactic antibiotics (cefazolin or vancomycin) for all of their neurointerventions while others generally do not.METHODSThe authors performed a retrospective review of the last 549 neurointerventional procedures in 484 patients at Tisch Hospital, NYU Langone Medical Center...
February 8, 2019: Journal of Neurosurgery
J M Ospel, G Gascou, V Costalat, L Piergallini, K A Blackham, D W Zumofen
BACKGROUND AND PURPOSE: The Sim&Size software simulates case-specific intraluminal Pipeline Embolization Device behavior, wall apposition, and device length in real-time on the basis of rotational angiography DICOM data. The purpose of this multicenter study was to evaluate whether preimplantation device simulation with the Sim&Size software results in selection of different device dimensions than manual sizing. MATERIALS AND METHODS: In a multicenter cohort of 74 patients undergoing aneurysm treatment with the Pipeline Embolization Device, we compared apparent optimal device dimensions determined by neurointerventionalists with considerable Pipeline Embolization Device experience based on manual 2D measurements taken from rotational angiography with computed optimal dimensions determined by Sim&Size experts blinded to the neurointerventionalists' decision...
February 7, 2019: AJNR. American Journal of Neuroradiology
Gaurav Girdhar, Samantha Ubl, Reza Jahanbekam, Sinduja Thinamany, Anna Belu, John Wainwright, Michael F Wolf
Flow diversion is a disruptive technology for the treatment of intracranial aneurysms. However, these intraluminal devices pose a risk for thromboembolic complications despite dual antiplatelet therapy. We report the thrombogenic potential of the following flow diversion devices measured experimentally in a novel human blood in-vitro pulsatile flow loop model: Pipeline™ Flex Embolization Device (Pipeline), Pipeline™ Flex Embolization Device with Shield Technology™ (Pipeline Shield), Derivo Embolization Device (Derivo), and P64 Flow Modulation Device (P64)...
March 2019: ENeurologicalSci
Danielle Golub, Lizbeth Hu, Siddhant Dogra, Jose Torres, Maksim Shapiro
Spontaneous cervical artery dissection (sCAD) is a major cause of stroke in young adults. Multiple sCAD is a rarer, more poorly understood presentation of sCAD that has been increasingly attributed to cervical trauma such as spinal manipulation or genetic polymorphisms in extracellular matrix components. The authors present the case of a 49-year-old, otherwise healthy woman, who over the course of 2 weeks developed progressive, hemodynamically significant, bilateral internal carotid artery and vertebral artery dissections...
February 1, 2019: Neurosurgical Focus
Ramesh Grandhi, Leonardo B C Brasiliense, Richard Williamson, Nathan T Zwagerman, Eric Sauvageau, Ricardo A Hanel
BACKGROUND: Massive epistaxis from rupture of an intracavernous internal carotid artery (ICA) aneurysm is a potentially fatal event. Although rare, this presentation is seen most often in patients after trauma or iatrogenic injury secondary to transsphenoidal surgery or radiation therapy. CASE DESCRIPTION: We present our unusual case of a patient with no significant risk factors who had recurrent epistaxis due to a ruptured true cavernous ICA aneurysm. The patient was treated initially with coil embolization followed by placement of a Pipeline Embolization Device (PED)...
February 1, 2019: World Neurosurgery
Peng Yan, Yupeng Zhang, Fei Liang, Chao Ma, Shikai Liang, Feng Guo, Chuhan Jiang
PURPOSE: To analyze and compare the safety and efficacy of different endovascular treatment modalities for unruptured intracranial large or giant aneurysms. METHODS: We retrospectively reviewed 126 consecutive patients with 128 large (15mm ≤size<25mm) or giant (≥ 25mm) aneurysms which were treated with different endovascular procedures between January 2014 and February 2017 in our center. We then compared clinical and angiographic outcomes, as well as the technical events rate among different treatment modalities...
January 28, 2019: World Neurosurgery
Fei Liang, Yupeng Zhang, Peng Yan, Chao Ma, Shikai Liang, Peng Jiang, Chuhan Jiang
OBJECTIVE: To explore the predictors of periprocedural complications and angiographic outcomes in large and giant intracranial posterior circulation aneurysms after endovascular treatment. METHODS: Ninety-nine patients with 103 large (size ≥10 mm, n=94) and giant (size >25 mm, n=9) posterior circulation aneurysms treated with endovascular therapy at a single center were retrospectively analyzed. Treatment procedures included endovascular trapping (n=15), coiling (n=6), stent only (n=10), stent-assisted coiling (n=48), and pipeline embolization device (PED, n=24)...
January 28, 2019: World Neurosurgery
Christopher T Primiani, Zeguang Ren, Peter Kan, Ricardo Hanel, Vitor Mendes Pereira, Wai Man Lui, Nitin Goyal, Lucas Elijovich, Adam S Arthur, David M Hasan, Santiago Ortega-Gutierrez, Edgar A Samaniego, Ajit S Puri, Anna L Kuhn, Kirill Orlov, Dmitry Kislitsin, Anton Gorbatykh, Muhammad Waqas, Elad I Levy, Adnan H Siddiqui, Maxim Mokin
BACKGROUND: Intracranial aneurysms located in the distal vessels are rare and remain a challenge to treat through surgical or endovascular interventions. OBJECTIVE: To describe a multicenter approach with flow diversion using the pipeline embolization device (PED) for treatment of distal intracranial aneurysms. METHODS: Cases of distal intracranial aneurysms defined as starting on or beyond the A2 anterior cerebral artery, M2 middle cerebral artery, and P2 posterior cerebral artery segments were included in the final analysis...
January 23, 2019: Journal of Neurointerventional Surgery
Eytan Raz, Maksim Shapiro, Razvan Buciuc, Peter Kim Nelson, Erez Nossek
BACKGROUND: The treatment of selected wide-neck and fusiform posterior circulation aneurysms is challenging for clipping as well as for endovascular route. OBJECTIVE: To describe an endovascular approach for vertebral artery aneurysm treatment using transradial access (TRA) instead of the conventional transfemoral access. METHODS: We collected cases from two institutions in which TRA was used for posterior circulation Pipeline Embolization Device (Medtronic, Dublin, Ireland) deployment...
January 22, 2019: Operative Neurosurgery (Hagerstown, Md.)
Al-Wala Awad, Craig Kilburg, Michael Karsy, William T Couldwell, Philipp Taussky
OBJECTIVEThe Pipeline embolization device (PED) is a self-expanding mesh stent that diverts blood flow away from an aneurysm; it has been successfully used to treat aneurysms of the proximal internal carotid artery (ICA). PEDs have a remarkable ability to alter regional blood flow along the tortuous segments of the ICA and were incidentally found to alter the angle of the anterior genu after treatment. The authors quantified these changes and explored their implications as they relate to treatment effect.METHODSThe authors retrospectively reviewed cases of aneurysms treated with a PED between the ophthalmic and posterior communicating arteries from 2012 through 2015...
January 18, 2019: Journal of Neurosurgery
Ajay Malhotra, Xiao Wu, Timothy Miller, Charles C Matouk, Pina Sanelli, Dheeraj Gandhi
OBJECTIVEBoth endovascular coiling and the Pipeline embolization device (PED) have been shown to be safe and clinically effective for treatment of small (< 10 mm) aneurysms. The authors conducted a comparative effectiveness analysis to compare the utility of these treatment methods in terms of health benefits.METHODSA decision-analytical study was performed with Markov modeling methods to simulate patients with small unruptured aneurysms undergoing endovascular coiling, stent-assisted coiling (SAC), or PED placement for treatment...
January 11, 2019: Journal of Neurosurgery
Jodi R DeGrote, Elizabeth M Olafson, Alexander Drofa, Evgueni Kouznetzov, Michael Manchak, Nathan D Leedahl, David D Leedahl
Background: Dual antiplatelet therapy with acetylsalicylic acid (ASA) and a P2Y12-receptor antagonist is often used to prevent thrombotic complications after placement of a Pipeline embolization device (PED) for cerebral aneurysm. Although clopidogrel is common in this setting, high rates of nonresponse to this drug have made ticagrelor a potentially attractive alternative. Objective: To describe safety and efficacy outcomes for ticagrelor following PED placement, including measurement of platelet function...
November 2018: Canadian Journal of Hospital Pharmacy
Scott B Raymond, Matthew J Koch, James D Rabinov, Thabele M Leslie-Mazwi, Collin M Torok, Christopher J Stapleton, Aman B Patel
OBJECTIVE: Flow diversion for treatment of intracranial aneurysms frequently necessitates covering adjacent branch vessels. Although branch vessel occlusion is common, associated clinical deficits are rare. We and others hypothesize that clinically silent branch vessel occlusion is due to underlying collateral circulation. To study the role of collateral circulation in covered branch vessel occlusion, we assessed collateral vessels and altered branch vessel flow on transfemoral catheter angiography in patients undergoing flow diversion of intracranial aneurysms...
December 26, 2018: World Neurosurgery
Matthew T Bender, Geoffrey P Colby, Alexander L Coon
No abstract text is available yet for this article.
December 13, 2018: Neurosurgery
Christoph J Griessenauer, Ajith J Thomas, Alejandro Enriquez-Marulanda, Aviraj Deshmukh, Abhi Jain, Christopher S Ogilvy, Naci Kocer, Tobias Engelhorn, Markus Möhlenbruch, Markus Holtmannspötter, Hendrik Janssen, Thomas Finkenzeller, Wolfgang Reith, Michael Sonnberger, Jan-Hendrik Buhk, Clemens M Schirmer, Monika Killer-Oberpfalzer
BACKGROUND: Flow diversion has become an accepted endovascular treatment modality for intracranial aneurysms. Studies comparing different types of flow diverters are currently lacking. OBJECTIVE: To perform a propensity score-matched cohort study comparing the Pipeline Embolization Device (PED; Medtronic, Dublin, Ireland) and Flow Redirection Endoluminal Device (FRED; MicroVention, Aliso Viejo, California). METHODS: Aneurysms of the internal carotid artery proximal to the communicating segment treated with PED at 2 neurovascular centers in the United States were matched with aneurysms treated in the European FRED study using propensity scoring...
December 12, 2018: Neurosurgery
Denise Brunozzi, Sophia F Shakur, Ali Alaraj
Flow diversion technology has revolutionized the treatment of complex anterior circulation cerebral aneurysms. However, vessel tortuosity and atherosclerotic disease may hamper the standard transfemoral access used in these procedures. Percutaneous direct carotid puncture is a viable alternative, but adequate carotid closure must be achieved. Here, we present the first case of a giant partially thrombosed aneurysm of the cavernous internal carotid artery treated with Pipeline Embolization Device (PED; ev3 Neurovascular, Irvine, CA) via direct carotid puncture...
December 6, 2018: World Neurosurgery
(no author information available yet)
OBJECTIVEDual antiplatelet therapy is required for the treatment of intracranial aneurysms with the Pipeline embolization device (PED). Platelet function testing (PFT) is often used to assess the efficacy of the antiplatelet regimen prior to PED placement. The optimal impedance values for whole blood aggregometry in this setting have not been defined.METHODSA retrospective review of a prospectively maintained database was performed for the years 2011-2015 to identify patients with intracranial aneurysms treated with the PED who underwent pretreatment PFT using whole blood aggregometry...
November 1, 2018: Journal of Neurosurgery
Adam N Wallace, Josser E Delgado Almandoz, Yasha Kayan, Jennifer L Fease, Jill M Scholz, Anna M Milner, Mary Thomas
BACKGROUND: The Pipeline embolization device (PED) has expanded the range of aneurysms amenable to endovascular treatment, including some that were previously untreatable. The PED contains several metals, including nickel, cobalt, chromium, platinum, and tungsten. The safety of PED implantation in patients with cutaneous metal allergy is unknown. The aim of this study was to assess clinical and angiographic outcomes of PED treatment in patients with cutaneous metal allergy. METHODS: A single-institution neurointerventional database was retrospectively reviewed for patients with documented cutaneous metal allergy who were treated with the PED...
November 23, 2018: World Neurosurgery
Amit Pujari, Brian Matthew Howard, Thomas P Madaelil, Susana Libhaber Skukalek, Anil K Roy, Jacques E Dion, C Michael Cawley, Jonathan A Grossberg
BACKGROUND: The pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied. METHODS: We conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded...
November 24, 2018: Journal of Neurointerventional Surgery
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