Use of the Pipeline embolization device for recurrent and residual cerebral aneurysms: a safety and efficacy analysis with short-term follow-up
Division of Neuroimaging and Intervention, Department of Radiology; New England Center for Stroke Research
Cardiovascular Diseases | Nervous System Diseases | Neurology | Radiology | Surgery
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.
Aneurysm, Coil, Flow Diverter, Intervention
DOI of Published Version
J Neurointerv Surg. 2017 Dec;9(12):1208-1213. doi: 10.1136/neurintsurg-2016-012772. Epub 2016 Nov 25. Link to article on publisher's site
Journal of neurointerventional surgery
Kuhn, Anna L.; de Macedo Rodrigues, Katyucia; Lozano, Juan Diego; Rex, David E.; Massari, Francesco; Tamura, Takamitsu; Howk, Mary; Brooks, Christopher; L'Heureux, Jenna; Gounis, Matthew J.; Wakhloo, Ajay K.; and Puri, Ajit S., "Use of the Pipeline embolization device for recurrent and residual cerebral aneurysms: a safety and efficacy analysis with short-term follow-up" (2017). Radiology Publications and Presentations. 407.