Open AccessPipeline Embolization for Salvage Treatment of Previously Stented Residual and Recurrent Cerebral Aneurysms
Author(s) -
Matthew T. Bender,
Chau D. Vo,
Bowen Jiang,
Jessica K. Campos,
David A. Zarrin,
Risheng Xu,
Erick M. Westbroek,
Justin M. Caplan,
Judy Huang,
Rafael J. Tamargo,
Li Lin,
Geoffrey P. Colby,
Alexander L. Coon
Publication year - 2018
Publication title -
interventional neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.07
H-Index - 5
eISSN - 1664-9737
pISSN - 1664-5545
DOI - 10.1159/000489018
Subject(s) - medicine , embolization , stent , aneurysm , balloon , thrombosis , flow diverter , internal carotid artery , surgery , stroke (engine) , abciximab , radiology , myocardial infarction , conventional pci , mechanical engineering , engineering
This study assessed the safety and effectiveness of the Pipeline embolization device (PED) for persistent and recurrent aneurysms previously treated with either a vascular reconstruction device (VRD) or a flow diverter (FD). Methods: A prospective, IRB-approved database was analyzed for patients treated with PED for aneurysms previously treated with a stent. Results: Twenty procedures were performed on 18 patients, 11 with prior FD, 7 with VRD, and 2 previously treated with both. Overall, 15 aneurysms were saccular (75%), and size was 13.5 ± 7.6 mm. Location was internal carotid artery (ICA) in 14 cases (70%) and posterior circulation in 6 cases (30%). Average prior treatments were 1.7. Previously FD cases were re-treated at an average of 18.1 months from most recent treatment. Each case used 1 device, 82% with distal coverage and 82% with proximal coverage of prior stent. Balloon remodeling was performed in 3 cases (27%) and no in-stent thrombosis was observed. Previously VRD stent-coiled cases were re-treated at an average of 87.5 months. These cases used on average 1.9 devices, 89% with distal and 100% proximal coverage. Adjunctive coiling was performed in 1 case (11%), balloon remodeling in 5 cases (56%), and 2 cases (28%) developed thrombosis that resolved with abciximab. Re-VRD cases were longer (59.1 vs. 33.7 min, p = 0.02) than re-FD. Angiographic follow-up was available for 16 cases (80%). In re-FD, occlusion was complete in 56% and partial progressive in 33% at 17.1 months digital subtraction angiography. In re-VRD, occlusion was complete in 57% and partial progressive in 27% at 8.1 months. Two complications occurred (10%), including one asymptomatic cervical ICA occlusion and one stent occlusion with associated mortality (5%). Clinical follow-up was 17.8 months on average (range 0.5–51.9). Conclusions: Salvage flow diversion for previously stented aneurysms is technically challenging but offers good prospects of aneurysm obliteration with acceptable complication rates.