Journal article
Treatment of Ruptured Intracranial Aneurysms With the Pipeline Embolization Device
Neurosurgery, Vol.76(2), pp.165-172
02/01/2015
DOI: 10.1227/NEU.0000000000000586
PMID: 25549187
Abstract
ABSTRACT
BACKGROUND:
The pipeline embolization device (PED) has been used for treatment of unruptured aneurysms. Little is known about the use of the PED in ruptured aneurysms.
OBJECTIVE:
To assess the safety and efficacy of the PED in ruptured intracranial aneurysms.
METHODS:
This is a case series with prospective data collection on 20 patients with freshly ruptured aneurysms who were treated with PED (with or without adjunctive coiling) at 2 cerebrovascular centers. Patients were loaded with aspirin and clopidogrel or received an infusion of tirofiban intraoperatively.
RESULTS:
Hunt and Hess grades were I in 7 patients (35%), II in 9 (45%), and III in 4 (20%). The mean duration from hemorrhage to PED placement was 7 ± 7.0 days. A single device was used in all but 1 patient (95%). The procedure was staged in 20%. There was only 1 complication (5%); this was a fatal intraoperative aneurysm dome rupture that occurred during adjunctive coil deployment. Adjunctive coiling was used in 30%. No patient required an invasive procedure after PED placement. Follow-up angiography (mean, 5.3 ± 4.2 months; range, 2-12 months) showed 100% occlusion in 12 (80%) and incomplete occlusion in 3 patients (20%). At latest follow-up, 19 patients achieved a favorable outcome (modified rankin scale 0–2).
CONCLUSION:
In our preliminary experience, treatment of ruptured aneurysms with the PED was associated with low complication rates, high occlusion rates, and favorable outcomes. These findings suggest that PED may be a safe and effective option for patients with favorable Hunt and Hess grades and aneurysms difficult to treat with conventional methods.
Details
- Title: Subtitle
- Treatment of Ruptured Intracranial Aneurysms With the Pipeline Embolization Device
- Creators
- Nohra Chalouhi - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PennsylvaniaMario Zanaty - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PennsylvaniaAlex Whiting - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PennsylvaniaStavropoula Tjoumakaris - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PennsylvaniaDavid Hasan - ‡Department of Neurosurgery, University of Iowa, Iowa City, IowaNorman Ajiboye - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PennsylvaniaShannon Hann - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PennsylvaniaRobert H Rosenwasser - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PennsylvaniaPascal Jabbour - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.76(2), pp.165-172
- DOI
- 10.1227/NEU.0000000000000586
- PMID
- 25549187
- NLM abbreviation
- Neurosurgery
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Publisher
- Oxford University Press
- Language
- English
- Date published
- 02/01/2015
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
- Record Identifier
- 9984040387102771
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