Incidence and Clinical Implications of Carotid Branch Occlusion Following Treatment of Internal Carotid Artery Aneurysms With the Pipeline Embolization Device

Vedantam, Aditya; Rao, Vikas Y.; Shaltoni, Hashem; Mawad, Michel E.

doi:10.1227/neu.0000000000000595

Cited by 59 publications

(46 citation statements)

References 16 publications

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“…12,42,75 Mortality rates ranged from 0% to 4.6% and 0% to 20% in ruptured cases. 51,75 Major concerns with coiling are coil prolapse into the parent vessel and coil penetration, which is estimated to be 2.5%. 72 Procedurerelated complications were comparable in the SAC group and the coiling-alone group.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the complications in the series were asymptomatic, and permanent morbidity rates ranged between 0% and 10%. 60,65,70,71,75 However, SAC of acutely ruptured aneurysms is associated with significantly higher complication rates (5%-25% vs 0%-16%) than unruptured aneurysms. 12,42,75 Mortality rates ranged from 0% to 4.6% and 0% to 20% in ruptured cases.…”

Section: Discussionmentioning

confidence: 99%

“…60,65,70,71,75 However, SAC of acutely ruptured aneurysms is associated with significantly higher complication rates (5%-25% vs 0%-16%) than unruptured aneurysms. 12,42,75 Mortality rates ranged from 0% to 4.6% and 0% to 20% in ruptured cases. 51,75 Major concerns with coiling are coil prolapse into the parent vessel and coil penetration, which is estimated to be 2.5%.…”

Section: Discussionmentioning

confidence: 99%

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Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis

Zhou

Yin

et al. 2017

Neurosurgical Focus

150

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OBJECTIVEThe objective of this study was to review the literature on the use of flow-diverting devices (FDDs) to treat intracranial aneurysms (IAs) and to investigate the safety and complications related to FDD treatment for IAs by performing a meta-analysis of published studies.METHODSA systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random-effects meta-analysis was used to pool the complication rates across studies.RESULTSSixty studies were included, which involved retrospectively collected data on 3125 patients. The use of FDDs was associated with an overall complication rate of 17.0% (95% confidence interval [CI] 13.6%–20.5%) and a low mortality rate of 2.8% (95% CI 1.2%–4.4%). The neurological morbidity rate was 4.5% (95% CI 3.2%–5.8%). No significant difference in the complication or mortality rate was observed between 2 commonly used devices (the Pipeline embolization device and the Silk flow-diverter device). A significantly higher overall complication rate was found in the case of ruptured IAs than in unruptured IA (odds ratio 2.3, 95% CI 1.2–4.3).CONCLUSIONSThe use of FDDs in the treatment of IAs yielded satisfactory results with regard to complications and the mortality rate. The risk of complications should be considered when deciding on treatment with FDDs. Further studies on the mechanism underlying the occurrence of adverse events are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis

Zhou

Yin

et al. 2017

Neurosurgical Focus

150

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“…Another study, of 49 patients with 68 carotid aneurysms, found an overall branch occlusion rate of 4.4% (4% of ophthalmic and 7.1% of posterior communicating arteries) without clinical sequelae at follow-up angiography. 9 A study of 11 patients with 13 carotid aneurysms in which the posterior communicating artery ostium was covered by one or more FDSs found an occlusion rate of 27%, with an additional 18% with diminished flow. 10 Finally, 2 reports with a combined total of 43 anterior choroidal arteries spanned by at least 1 FDS in the treatment of carotid aneurysms documented 2 branch occlusions (4.7%) at follow-up, without clinical sequelae.…”

Section: Discussionmentioning

confidence: 99%

Posterior Inferior Cerebellar Artery Patency after Flow-Diverting Stent Treatment

Levitt

Park

Albuquerque

et al. 2015

AJNR Am J Neuroradiol

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“…10) Several studies indicated that PED insertion at the origin of the ophthalmic artery did not frequently cause occlusion of the ophthalmic artery or clinical ocular symptoms. 15,16) On the other hand, a study reported that detailed ophthalmological examination of 28 patients in whom the PED was inserted showed ophthalmological complications in 39.3% even in the absence of signs; caution is needed. 17) With respect to changes in stent morphology after FRED insertion, Kocer et al reported stent foreshortening the day after treatment in one patient.…”

Section: Resultsmentioning

confidence: 99%

Use of a Flow Re-direction Endoluminal Device (FRED) for Wide-neck Large/Giant Cerebral Aneurysms

Matsumaru

Amano

Sato

2017

NOUSHINKEI KEKKANNAI TIRYOU

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Objective: There are some reports concerning the effectiveness of flow-diverter (FD) stents for untreatable cerebral aneurysm by conventional surgery and endovascular treatment. Treatment with a Pipeline embolization device, one of the original FD stents, has just started in Japan. We report herewith our initial experience of Flow Re-direction Endoluminal Device (FRED), which is a new FD with unique double layer structures, for wide-neck large or giant cerebral aneurysms. Materials and Methods:This report is part of a clinical trial for the approval of FRED in Japan with permission of the Institutional Review Board of Toranomon Hospital. Between October 2014 and January 2015, we treated six aneurysms in six patients with FRED including three cavernous and three paraclinoid aneurysms, three asymptomatic and three symptomatic aneurysms, four large and two giant aneurysms.Results: All patients were treated with single FRED without any coils. There were no transient ischemic attack, no stroke and no death in peri-and post-operative periods. One patient's preexisting eye symptom temporarily worsened. Followup angiography at 6 months showed no filling (O'Kelly Marotta scale: D) in two patients, entry remnant (OKM scale C) in two patients, and subtotal filling (OKM scale B) in two patients. Conclusion:Treatments using FRED were achieved without any severe complication. Clinical trials will continue to demonstrate its safety and efficacy for complex aneurysms.

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Incidence and Clinical Implications of Carotid Branch Occlusion Following Treatment of Internal Carotid Artery Aneurysms With the Pipeline Embolization Device

Abstract: The incidence of major supraclinoid ICA branch occlusion after treatment with PEDs was low. These events were not associated with new neurological deficits nor were they related to the number of PEDs deployed or the origin of ICA branches from the aneurysm.

Cited by 59 publications

References 16 publications

Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis

Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis

Posterior Inferior Cerebellar Artery Patency after Flow-Diverting Stent Treatment

Use of a Flow Re-direction Endoluminal Device (FRED) for Wide-neck Large/Giant Cerebral Aneurysms

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