Pipeline Embolization Device for the Treatment of Intracranial Pseudoaneurysms

Stephanie H Chen; David J McCarthy; Dallas Sheinberg; Ricardo Hanel; Samir Sur; Pascal Jabbour; Elias Atallah; Nohra Chalouhi; Aaron Dumont; Peter Amenta; David Hasan; Daniel Raper; Kenneth Liu; John A Jane; R. Webster Crowley; Pedro Aguilar-Salinas; Josh Bentley; Stephen Monteith; Bartley D Mitchell; Dileep R Yavagal; Eric C Peterson; Robert M Starke

doi:10.1016/j.wneu.2019.02.135

Back

Pipeline Embolization Device for the Treatment of Intracranial Pseudoaneurysms

Journal article

Peer reviewed

Pipeline Embolization Device for the Treatment of Intracranial Pseudoaneurysms

Stephanie H Chen, David J McCarthy, Dallas Sheinberg, Ricardo Hanel, Samir Sur, Pascal Jabbour, Elias Atallah, Nohra Chalouhi, Aaron Dumont, Peter Amenta, …

World neurosurgery, Vol.127, pp.e86-e93

07/2019

DOI: 10.1016/j.wneu.2019.02.135

PMID: 30849553

View Online

Abstract

Intracranial pseudoaneurysms (PSAs) are associated with high rupture and mortality rates and have traditionally been treated by parent vessel sacrifice. There has been recent interest in using flow-diverting devices for treatment of these complex lesions while preserving flow through the parent artery. The objective of this study is to examine the safety and efficacy of these devices in the treatment of intracranial PSA. We performed a multi-institutional retrospective study of intracranial PSAs treated with the Pipeline Embolization Device (PED) between 2014 and 2017 at 7 institutions. Complications and clinical and radiographic outcomes were reviewed. A total of 19 patients underwent PED placement for intracranial PSA. Iatrogenic injury and trauma comprised most etiologies in our series. The mean pseudoaneurysm diameter was 8.8 mm, and 18 of 19 PSAs (95%) involved the internal carotid artery (ICA). Multiple PEDs were deployed in a telescoping fashion in 7 patients (37%). Of the 18 patients with follow up imaging, 14 (78%) achieved complete pseudoaneurysm obliteration and 2 achieved near-complete obliteration (11%). Two patients (11%) were found to have significant pseudoaneurysm progression on short-term follow-up and required ICA sacrifice. No patients experienced new neurologic deficits or deterioration secondary to PED placement. No patients experienced bleeding or rebleeding from PSA. In well-selected patients, the use of flow-diverting stents may be a feasible alternative to parent vessel sacrifice. Given the high morbidity and mortality associated with PSA, we recommend short- and long-term radiographic follow-up for patients treated with flow-diverting stents.

Infection

Iatrogenic

Bypass

Subarachnoid hemorrhage

Endovascular

Aneurysm

Clipping

Flow diversion

Sacrifice

Trauma

Pseudoaneurysm

Pipeline

Details

Title: Subtitle: Pipeline Embolization Device for the Treatment of Intracranial Pseudoaneurysms
Creators: Stephanie H Chen - Department of Neurological Surgery, University of Miami, Miami, Florida, USA
David J McCarthy - Department of Neurological Surgery, University of Miami, Miami, Florida, USA
Dallas Sheinberg - Department of Neurological Surgery, University of Miami, Miami, Florida, USA
Ricardo Hanel - Department of Neurological Surgery, University of Miami, Miami, Florida, USA
Samir Sur - Department of Neurological Surgery, University of Miami, Miami, Florida, USA
Pascal Jabbour - Department of Neurological Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
Elias Atallah - Department of Neurological Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
Nohra Chalouhi - Department of Neurological Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
Aaron Dumont - Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
Peter Amenta - Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
David Hasan - Department of Neurological Surgery, University of Iowa, Iowa City, Iowa, USA
Daniel Raper - Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
Kenneth Liu - Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
John A Jane - Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
R. Webster Crowley - Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
Pedro Aguilar-Salinas - Department of Neurological Surgery, Baptist Health, Miami, Florida, USA
Josh Bentley - Department of Neurological Surgery, Swedish Health, Seattle, Washington, USA
Stephen Monteith - Department of Neurological Surgery, Swedish Health, Seattle, Washington, USA
Bartley D Mitchell - Department of Neurological Surgery, Methodist Institute, Houston, Texas, USA
Dileep R Yavagal - Department of Neurological Surgery, University of Miami, Miami, Florida, USA
Eric C Peterson - Department of Neurological Surgery, University of Miami, Miami, Florida, USA
Robert M Starke - Department of Neurological Surgery, University of Miami, Miami, Florida, USA
Resource Type: Journal article
Publication Details: World neurosurgery, Vol.127, pp.e86-e93
Publisher: Elsevier Inc
DOI: 10.1016/j.wneu.2019.02.135
PMID: 30849553
ISSN: 1878-8750
eISSN: 1878-8769
Language: English
Date published: 07/2019
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Neurosurgery; Otolaryngology
Record Identifier: 9984040340602771

Metrics

20 Record Views

30 Times Cited - Web of Science

See more details