Safety and efficacy of the Pipeline Flex embolization device with Shield Technology for the acute treatment of ruptured internal carotid artery pseudoaneurysms: a multi-institution case series

Michael T Bounajem; Evan Joyce; Jonathan P Scoville; Joshua Seinfeld; Jessa Hoffman; Jonathan A Grossberg; Vanesha Waiters; Andrew C White; John Nerva; Jan-Karl Burkhardt; Daniel A Tonetti; Kareem El Naamani; M Reid Gooch; Pascal Jabbour; Stavropoula Tjoumakaris; Santiago Ortega Gutierrez; Michael R Levitt; Michael Lang; William J Ares; Sohum Desai; Justin R Mascitelli; Craig J Kilburg; Karol P Budohoski; William T Couldwell; Bradley A Gross; Ramesh Grandhi

doi:10.3171/2023.2.FOCUS233

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Safety and efficacy of the Pipeline Flex embolization device with Shield Technology for the acute treatment of ruptured internal carotid artery pseudoaneurysms: a multi-institution case series

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Safety and efficacy of the Pipeline Flex embolization device with Shield Technology for the acute treatment of ruptured internal carotid artery pseudoaneurysms: a multi-institution case series

Michael T Bounajem, Evan Joyce, Jonathan P Scoville, Joshua Seinfeld, Jessa Hoffman, Jonathan A Grossberg, Vanesha Waiters, Andrew C White, John Nerva, Jan-Karl Burkhardt, …

Neurosurgical focus, Vol.54(5), E4

05/2023

DOI: 10.3171/2023.2.FOCUS233

PMID: 37127036

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Abstract

Ruptured blister, dissecting, and iatrogenic pseudoaneurysms are rare pathologies that pose significant challenges from a treatment standpoint. Endovascular treatment via flow diversion represents an increasingly popular option; however, drawbacks include the requirement for dual antiplatelet therapy and the potential for thromboembolic complications, particularly acute complications in the ruptured setting. The Pipeline Flex embolization device with Shield Technology (PED-Shield) offers reduced material thrombogenicity, which may aid in the treatment of ruptured internal carotid artery pseudoaneurysms. The authors conducted a multi-institution, retrospective case series to determine the safety and efficacy of PED-Shield for the treatment of ruptured blister, dissecting, and iatrogenic pseudoaneurysms of the internal carotid artery. Clinical, radiographic, treatment, and outcomes data were collected. Thirty-three patients were included in the final analysis. Seventeen underwent placement of a single device, and 16 underwent placement of two devices. No thromboembolic complications occurred. Four patients were maintained on aspirin alone, and all others were treated with long-term dual antiplatelet therapy. Among patients with 3-month follow-up, 93.8% had a modified Rankin Scale score of 0-2. Complete occlusion at follow-up was observed in 82.6% of patients. PED-Shield represents a new option for the treatment of ruptured blister, dissecting, and iatrogenic pseudoaneurysms of the internal carotid artery. The reduced material thrombogenicity appeared to improve the safety of the PED-Shield device, as this series demonstrated no thromboembolic complications even among patients treated with only single antiplatelet therapy. The efficacy of PED-Shield reported in this series, particularly with placement of two devices, demonstrates its potential as a first-line treatment option for these pathologies.

Aneurysm, False - etiology

Aneurysm, False - therapy

Blister

Carotid Artery, Internal

Cerebral Angiography

Embolization, Therapeutic

Humans

Iatrogenic Disease

Intracranial Aneurysm - therapy

Platelet Aggregation Inhibitors

Retrospective Studies

Thromboembolism

Treatment Outcome

Details

Title: Subtitle: Safety and efficacy of the Pipeline Flex embolization device with Shield Technology for the acute treatment of ruptured internal carotid artery pseudoaneurysms: a multi-institution case series
Creators: Michael T Bounajem - University of Utah
Evan Joyce - University of Utah
Jonathan P Scoville - University of Utah
Joshua Seinfeld - University of Colorado Anschutz Medical Campus
Jessa Hoffman - University of Colorado Anschutz Medical Campus
Jonathan A Grossberg - Emory University
Vanesha Waiters - Morehouse School of Medicine
Andrew C White - The University of Texas Southwestern Medical Center
John Nerva - Medical College of Wisconsin
Jan-Karl Burkhardt - University of Pennsylvania
Daniel A Tonetti - Cooper Medical School of Rowan University
Kareem El Naamani - Thomas Jefferson University
M Reid Gooch - Thomas Jefferson University
Pascal Jabbour - Thomas Jefferson University
Stavropoula Tjoumakaris - Thomas Jefferson University
Santiago Ortega Gutierrez - University of Iowa
Michael R Levitt - University of Washington
Michael Lang - University of Pittsburgh Medical Center
William J Ares - NorthShore University HealthSystem
Sohum Desai - The University of Texas Rio Grande Valley
Justin R Mascitelli - The University of Texas Health Science Center at San Antonio
Craig J Kilburg - University of Utah
Karol P Budohoski - University of Utah
William T Couldwell - University of Utah
Bradley A Gross - University of Pittsburgh Medical Center
Ramesh Grandhi - University of Utah
Resource Type: Journal article
Publication Details: Neurosurgical focus, Vol.54(5), E4
DOI: 10.3171/2023.2.FOCUS233
PMID: 37127036
NLM abbreviation: Neurosurg Focus
eISSN: 1092-0684
Language: English
Date published: 05/2023
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984400759902771

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