Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections

8:32 PM Posted by Dr Subhash Kumar, MBBS, MD, DM

This study to date is the largest registry of the flow diversion devices: PIPELINE or SILK.
The authors, here too, like all other smaller studies, have said that the complication rates are acceptable.
This study had 6 major complications in the 90 aneurysms followed up, only 52% had complete occlusion, 66% needed multiple stents which are exorbitantly costly...wonder what the definition of 'acceptable complication rate' is...which most of these studies say...no doubt industry sponsored.
But where ever feasible why not do a parent vessel sacrifice, which is much more safe, durable and cheap...or...use stent grafts/enterprise stent which are much cheaper than the flow diverters..

Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections:

Abstract

Introduction
The purpose of this study was to evaluate the safety and efficacy of the recently available flow diverter “pipeline embolization
device” (PED) for the treatment of intracranial aneurysms and dissections.

Methods
Eighty-eight consecutive patients underwent an endovascular treatment of 101 intracranial aneurysms or dissections using the
PED between September 2009 and January 2011. The targeted vessels include 79 (78%) in the anterior circulation and 22 (22%)
in the posterior circulation. We treated 96 aneurysms and 5 vessel dissections. Multiple devices were implanted in 67 lesions
(66%).

Results
One technical failure of the procedure was encountered. Immediate exclusion of the target lesion was not observed. Angiographic
follow-up examinations were carried out in 80 patients (91%) with 90 lesions and revealed complete cure of the target lesion(s)
in 47 (52%), morphological improvement in 32 lesions (36%), and no improvement in 11 lesions (12%). Six major complications
were encountered: one fatal aneurysm rupture, one acute and one delayed PED thrombosis, and three hemorrhages in the dependent
brain parenchyma.

Conclusion
Our experience reveals that the PED procedure is technically straightforward for the treatment of selected wide-necked saccular
aneurysms, fusiform aneurysms, remnants of aneurysms, aneurysms with a high likelihood of failure with conventional endovascular
techniques, and dissected vessels. While vessel reconstruction, performed after dissection, is achieved within days, remodeling
of aneurysmal dilatations may take several months. Dual platelet inhibition is obligatory. Parenchymal bleeding into brain
areas dependent on the target vessel is uncommon.


DOI 10.1007/s00234-011-0948-x
  • Authors

    • Sebastian Fischer, Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
    • Zsolt Vajda, Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
    • Marta Aguilar Perez, Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
    • Elisabeth Schmid, Neurologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
    • Nikolai Hopf, Neurochirurgische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
    • Hansjörg Bäzner, Neurologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
    • Hans Henkes, Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany





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