Background And Importance: The safety of flow-diverting stents for the treatment of ruptured intracranial aneurysms is unknown.
Clinical Presentation: A 35-year-old woman with a ruptured dissecting aneurysm of the intradural right vertebral artery and incorporating the right posterior inferior cerebellar artery was treated with a Pipeline Embolization Device (PED). Five days after reconstruction of the diseased right vertebral segment, she was treated for vasospasm, and retraction of the PED was observed, leaving her dissecting aneurysm unprotected. A second PED was placed with coverage of the aneurysm, but vasospasm complicated optimal positioning of the device.
Conclusion: In addition to the potential risks of dual antiplatelet therapy in these patients, this case illustrates 2 pitfalls of flow-diverting devices in vessels in vasospasm: delayed retraction of the device and difficulty positioning the device for deployment in the setting of vasospasm.
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| http://dx.doi.org/10.1227/NEU.0b013e31827fc9be | DOI Listing |
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Evolving treatment paradigms of cerebral aneurysm stasis in flow diversion.
J Clin Neurosci
December 2024
Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address:
Introduction: Flow diversion is an effective first-line treatment for intracranial aneurysms; however, the rate of incomplete occlusion is not insignificant. Data in neuroendovascular literature is limited regarding the implications of persistent incomplete occlusion despite flow diversion.
Methods: We conducted a retrospective analysis of a prospectively maintained database and identified 125 consecutive patients with treatment naïve intracranial aneurysms who underwent flow diversion with the PED from April 2014 - November 2022.
Comparative analysis of safety and efficacy of flow diversion with and without surface modification technology, FRED-X, FRED, PED shield and PED in 386 patients: A single center experience with systematic review and network meta analysis.
J Neurol Sci
December 2024
Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address:
Introduction: The FRED-X is a newer generation flow diverting stent (FDS) with surface modification that has demonstrated favorable efficacy in treating intracranial aneurysms. Our study provides an analysis of patients treated using FRED-X compared to FRED, PED Shield and PED.
Materials And Methods: This was a retrospective single center study and a systematic review with network meta analysis of patients who underwent flow diversion using FRED-X, FRED, PED Shield or PED.
The Pipeline Embolization Device for the Intracranial Treatment of Aneurysms Trial.
AJNR Am J Neuroradiol
December 2024
Emergent salvage of the vertebral artery with flow diverter pipeline stent following vessel laceration: Systematic literature review and illustrative case example.
Surg Neurol Int
November 2024
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma, United States.
Background: Iatrogenic injury to neck vasculature is a potentially life-threatening complication of spine surgery. We present an illustrative case describing the use of the Pipeline Embolization Device (PED) in the emergent reconstruction of the vertebral artery (VA) following vessel laceration. In addition, we document a systematic review concerning the use of the PED in acute to chronic iatrogenic injury of the internal carotid or VAs.
View Article and Find Full Text PDFFourth-generation Pipeline Vantage flow diversion: First reported US experience of safety and feasibility.
Interv Neuroradiol
December 2024
Department of Neurology, University of Chicago, Chicago, IL, USA.
Article Synopsis
- The Pipeline Vantage embolization device is a new fourth-generation tool designed to treat intracranial aneurysms, and this study evaluates its safety and effectiveness.
- The research involved 12 patients, primarily women, with a variety of aneurysm types, and demonstrated a 100% success rate in device deployment without intraoperative complications.
- One postprocedural complication occurred, and the findings represent the first US analysis of this device's use in patients with intracranial aneurysms, highlighting its potential for treating both ruptured and unruptured cases.
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