Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections
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
DOI 10.1007/s00234-011-0948-x
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%).
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.
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.
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.
- 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
- Journal Neuroradiology
- Online ISSN 1432-1920
- Print ISSN 0028-3940
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Treatment of intracranial aneurysms. Reconstruction of the parent artery with flow-diverting (Silk) stent
Treatment of intracranial aneurysms. Reconstruction of the parent artery with flow-diverting (Silk) stent:
Abstract
Introduction
Since the flow diverters (FDs) have been introduced it is possible to treat aneurysms that are considered difficult or impossible
to treat with usual endovascular or surgical methods. It is still uncertain which aneurysms are suitable for this new treatment.
We present the periprocedural complications, immediate result, late complications, imaging follow-up at 6 and 12 months and
clinical follow-up at 2–23 months.
to treat with usual endovascular or surgical methods. It is still uncertain which aneurysms are suitable for this new treatment.
We present the periprocedural complications, immediate result, late complications, imaging follow-up at 6 and 12 months and
clinical follow-up at 2–23 months.
Results
Periprocedural complications were seen in four treatments (17%). However, none of these had clinical consequences. Mortality
and morbidity rates were 1 of 22 (5%) and 1 of 22 (5%), respectively. Clinical outcome was unchanged in 16 patients (72%),
3 patients improved (14%) and 3 patients worsened (14%). The end-of-procedure angiography did not show complete occlusion
of any of the aneurysms, but at 6 months follow-up angiography, 17 of 25 aneurysms (68%) were completely occluded, and at
12 months, 18 of 21 aneurysms (86%) were occluded.
and morbidity rates were 1 of 22 (5%) and 1 of 22 (5%), respectively. Clinical outcome was unchanged in 16 patients (72%),
3 patients improved (14%) and 3 patients worsened (14%). The end-of-procedure angiography did not show complete occlusion
of any of the aneurysms, but at 6 months follow-up angiography, 17 of 25 aneurysms (68%) were completely occluded, and at
12 months, 18 of 21 aneurysms (86%) were occluded.
Conclusion
The effect of the Silk FD in terms of occlusion of the aneurysms seems to occur mainly during the first 6 months after placement
but continues during the following time. Most delayed complications occur immediately after discontinuing the anticoagulation
medication. Considering the complexity of the aneurysms treated, the rate of complications is acceptable.
but continues during the following time. Most delayed complications occur immediately after discontinuing the anticoagulation
medication. Considering the complexity of the aneurysms treated, the rate of complications is acceptable.
- Content Type Journal Article
- Category Interventional Neuroradiology
- Pages 1-10
- DOI 10.1007/s00234-011-0949-9
- Authors
- Aase Wagner, Department of Neuroradiology, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Marie Cortsen, Department of Neuroradiology, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- John Hauerberg, Department of Neurosurgery, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Bertil Romner, Department of Neurosurgery, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Mathias Pedersen Wagner, Department of Neuroradiology, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Journal Neuroradiology
- Online ISSN 1432-1920
- Print ISSN 0028-3940
This is a small patient group who underwent flow diversion with the SILK stent. 1/22 died and 1/22 had clinical deficits. 18/22 aneurysms occluded at 1 year. I do not think these results are really very good
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The value of magnetic resonance imaging for the detection of the bleeding source in non-traumatic intracerebral haemorrhages: a comparison with conventional digital subtraction angiography
Three cheers for non invasive imaging...
The value of magnetic resonance imaging for the detection of the bleeding source in non-traumatic intracerebral haemorrhages: a comparison with conventional digital subtraction angiography:
Abstract
Introduction
Conventional digital subtraction angiography (DSA) is currently regarded as the gold standard in detecting underlying vascular
pathologies in patients with intracerebral haemorrhages (ICH). However, the use of magnetic resonance imaging (MRI) in the
diagnostic workup of ICHs has considerably increased in recent years. Our aim was to evaluate the diagnostic accuracy and
yield of MRI for the detection of the underlying aetiology in ICH patients.
pathologies in patients with intracerebral haemorrhages (ICH). However, the use of magnetic resonance imaging (MRI) in the
diagnostic workup of ICHs has considerably increased in recent years. Our aim was to evaluate the diagnostic accuracy and
yield of MRI for the detection of the underlying aetiology in ICH patients.
Methods
Sixty-seven consecutive patients with an acute ICH who underwent MRI (including magnetic resonance angiography (MRA) and DSA
during their diagnostic workup) were included in the study. Magnetic resonance images were retrospectively analysed by two
independent neuroradiologists to determine the localisation and cause of the ICH. DSA was used as a reference standard.
during their diagnostic workup) were included in the study. Magnetic resonance images were retrospectively analysed by two
independent neuroradiologists to determine the localisation and cause of the ICH. DSA was used as a reference standard.
Results
In seven patients (10.4%), a DSA-positive vascular aetiology was present (one aneurysm, four arteriovenous malformations,
one dural arteriovenous fistula and one vasculitis). All of these cases were correctly diagnosed by both readers on MRI. In
addition, MRI revealed the following probable bleeding causes in 39 of the 60 DSA-negative patients: cerebral amyloid angiopathy
(17), cavernoma (9), arterial hypertension (8), haemorrhagic transformation of an ischaemic infarction (3) and malignant brain
tumour with secondary ICH (2).
one dural arteriovenous fistula and one vasculitis). All of these cases were correctly diagnosed by both readers on MRI. In
addition, MRI revealed the following probable bleeding causes in 39 of the 60 DSA-negative patients: cerebral amyloid angiopathy
(17), cavernoma (9), arterial hypertension (8), haemorrhagic transformation of an ischaemic infarction (3) and malignant brain
tumour with secondary ICH (2).
Conclusion
Performing MRI with MRA proved to be an accurate diagnostic tool in detecting vascular malformations in patients with ICH.
In addition, MRI provided valuable information regarding DSA-negative ICH causes, and thus had a high diagnostic yield in
ICH patients.
In addition, MRI provided valuable information regarding DSA-negative ICH causes, and thus had a high diagnostic yield in
ICH patients.
- Content Type Journal Article
- Category Diagnostic Neuroradiology
- Pages 1-8
- DOI 10.1007/s00234-011-0953-0
- Authors
- Nina Lummel, Department of Neuroradiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Jürgen Lutz, Department of Neuroradiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Hartmut Brückmann, Department of Neuroradiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Jennifer Linn, Department of Neuroradiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Journal Neuroradiology
- Online ISSN 1432-1920
- Print ISSN 0028-3940
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