Pipeline Embolization Device for Large/Giant or Fusiform Aneurysms: An Initial Multi-Center Experience in Korea

Kim, Byung Moon; Shin, Yong Sam; Baik, Min Woo; Lee, Deok Hee; Jeon, Pyoung; Baik, Seung Kug; Lee, Tae Hong; Kang, Donghoon; Suh, Sangil; Byun, Jun Soo; Jung, Jin‐Young; Kwon, Ki-Hun; Kim, Dong Joon; Park, Keun Young; Kim, Bum Soo; Park, Jung Cheol; Kim, Seong Rim; Kim, Young Woo; Kim, Hoon; Jo, Kyung-Il; Yoon, Chang Hyo; Kim, Young Soo

doi:10.5469/neuroint.2016.11.1.10

Cited by 34 publications

(19 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This highlights the efficacy of the PED that resulted in a rate of aneurysm occlusion of 81.5% after a 5-year experience with the device. This rate is consistent with those reported in other studies in the literature that have shown a high complete aneurysm occlusion rate, with most studies reporting occlusion rates > 80%, 11,16 which compares favorably to that of endovascular coil embolization, where the reported complete occlusion rate is 66% (ISAT; International Subarachnoid Aneurysm Trial). 23 None of the aneurysms with complete occlusion or near-complete occlusion recurred during follow-up.…”

Section: Discussionsupporting

confidence: 89%

“…Good clinical outcomes have been reported with flow diversion of saccular or nonsymptomatic fusiform posterior circulation aneurysms. 16 Acceptable morbidity and mortality rates (0%-9.4%) and high efficacy have been shown in these aneurysms, 85.2% in this study, comparable to anterior circulation aneurysms. Treatment with the PED may be a preferable alternative to open surgical treatment for these aneurysms.…”

Section: Aneurysm Locationsupporting

confidence: 62%

“…Coiling and flow diversion have been shown to be complementary, rather than competitive, modalities for intracranial aneurysm treatment. 16 Using coils along with the PED in select cases can be more effective, with a higher occlusion rate and lower re-treatment rate, by promoting endosaccular thrombosis and providing a mechanical scaffold.…”

Section: Aneurysm Locationmentioning

confidence: 99%

See 2 more Smart Citations

Aneurysms with persistent filling after failed treatment with the Pipeline embolization device

Daou

Atallah

Chalouhi

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVEThe Pipeline embolization device (PED) has become a valuable tool in the treatment of cerebral aneurysms. Although failures with PED treatment have been reported, the characteristics and course of these aneurysms remain a topic of uncertainty.METHODSElectronic medical records and imaging studies were reviewed for all patients treated with the PED between July 2010 and March 2015 to identify characteristics of patients and aneurysms with residual filling after PED treatment.RESULTSOf 316 cases treated at a single institution, 281 patients had a long-term follow-up. A total of 52 (16.4%) aneurysms with residual filling were identified and constituted the study population. The mean patient age in this population was 58.8 years. The mean aneurysm size was 10.1 mm ± 7.15 mm. Twelve aneurysms were fusiform (23%). Of the aneurysms with residual filling, there were 20 carotid ophthalmic (CO) aneurysms (20% of all CO aneurysms treated), 10 other paraclinoid aneurysms (16.4% of all paraclinoid aneurysms), 7 posterior communicating artery (PCoA) aneurysms (21.9% of all PCoA aneurysms), 7 cavernous internal carotid artery (ICA) aneurysms (14.9% of all cavernous ICA aneurysms), 4 vertebrobasilar (VB) junction aneurysms (14.8% of all VB junction aneurysms), and 3 middle cerebral artery (MCA) aneurysms (25% of all MCA aneurysms). Eleven patients underwent placement of more than one PED (21.2%), with a mean number of devices of 1.28 per case. Eight of 12 aneurysms were previously treated with a stent (15.4%). Nineteen patients underwent re-treatment (36.5%); the 33 patients who did not undergo re-treatment (63.5%) were monitored by angiography or noninvasive imaging. In multivariate analysis, age older than 65 years (OR 2.65, 95% CI 1.33–5.28; p = 0.05), prior stent placement across the target aneurysm (OR 2.94, 95% CI 1.15–7.51; p = 0.02), aneurysm location in the distal anterior circulation (MCA, PCoA, and anterior choroidal artery: OR 2.72, 95% CI 1.19–6.18; p = 0.017), and longer follow-up duration (OR 1.06, 95% CI 1.03–1.09; p < 0.001) were associated with incomplete aneurysm occlusion.CONCLUSIONSWhile the PED can allow for treatment of large, broad-necked aneurysms with high efficacy, treatment failures do occur (16.4%). Aneurysm size, shape, and previous treatment may influence treatment outcome.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Aneurysm Locationsupporting

confidence: 62%

Section: Aneurysm Locationmentioning

confidence: 99%

See 1 more Smart Citation

Aneurysms with persistent filling after failed treatment with the Pipeline embolization device

Daou

Atallah

Chalouhi

et al. 2019

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Their series reported minor complications in 7.6% (4.2% transient J Korean Neurosurg Soc 63 (2) : 137-152 ischemic attacks; 3.4% minor stroke) and major complications in 1.6% (0.8% major stroke; 0.8% mortality 23) . In a similar study, Kim et al 60) reported 77.4% complete occlusion rate at 2-years for large/giant (>15 mm) intracranial aneurysms undergoing FDS placement. They reported a 4.4% procedural morbidity rate and no mortality.…”

Section: Wide-necked Large and Giant Aneurysmsmentioning

confidence: 77%

The Evolution of Flow-Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction

Shin

Carroll

Elghareeb

et al. 2020

J Korean Neurosurg Soc

View full text Add to dashboard Cite

In spite of the developing endovascular era, large (15-25 mm) and giant (>25 mm) wide-neck cerebral aneurysms remained technically challenging. Intracranial flow-diverting stents (FDS) were developed to address these challenges by targeting aneurysm hemodynamics to promote aneurysm occlusion. In 2011, the first FDS approved for use in the United States market. Shortly thereafter, the Pipeline of Uncoilable or Failed Aneurysms (PUFS) study was published demonstrating high efficacy and a similar complication profile to other intracranial stents. The initial FDA instructions for use (IFU) limited its use to patients 22 years old or older with wide-necked large or giant aneurysms of the internal carotid artery (ICA) from the petrous segment to superior hypophyseal artery/ophthalmic segment. Expanded IFU was tested in the Prospective Study on Embolization of Intracranial Aneurysms with PipelineTM Embolization Device (PREMIER) trial. With further post-approval clinical data, the United States FDA expanded the IFU to include patients with small or medium, wide-necked saccular or fusiform aneurysms from the petrous ICA to the ICA terminus. However, IFU is more restrictive in South Korea than in United States. Several systematic reviews and meta-analyses have sought to evaluate the overall efficacy of FDS for the treatment of cerebral aneurysms and consistently identify FDS as an effective technique for the treatment of aneurysms broadly with complication rates similar to other traditional techniques. A growing body of literature has demonstrated high efficacy of FDS for small aneurysms; distal artery aneurysms; non-saccular aneurysms posterior circulation aneurysms and complication rates similar to traditional techniques. In the short interval since the Pipeline Embolization Device was first introduced, FDS has been firmly entrenched as a powerful tool in the endovascular armamentarium. As new FDS are developed, established FDS are refined, and delivery systems are improved the uses for FDS will only expand further. Researchers continue to work to optimize the mechanical characteristics of the FDS themselves, aiming to optimize deploy ability and efficacy. With expanded use for small to medium aneurysms and posterior circulation aneurysms, FDS technology is firmly entrenched as a powerful tool to treat challenging aneurysms, both primarily and as an adjunct to coil embolization. With the aforementioned advances, the ease of FDS deployment will improve and complication rates will be further minimized. This will only further establish FDS deployment as a key strategy in the treatment of cerebral aneurysms.

show abstract

“…However, this involves repeat craniotomy and delays tumor surgery, more than the preoperative coiling strategy. Endovascular treatment of UIA is very safe and effective even in wide neck and large aneurysms (20212223). Thus, cUIA coiling and subsequent tumor surgery is an alternative option.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery

Park

Kim

2016

Korean J Radiol

Self Cite

View full text Add to dashboard Cite

ObjectiveFew studies have investigated treatment strategies for brain tumor with a coexisting unruptured intracranial aneurysm (cUIA). The purpose of this study was to evaluate the safety and efficacy of preoperative coiling for cUIA, and subsequent brain tumor surgery.Materials and MethodsA total of 19 patients (mean age, 55.2 years; M:F = 4:15) underwent preoperative coiling for 23 cUIAs and subsequent brain tumor surgery. Primary brain tumors were meningiomas (n = 7, 36.8%), pituitary adenomas (n = 7, 36.8%), gliomas (n = 3, 15.8%), vestibular schwannoma (n = 1, 5.3%), and Rathke's cleft cyst (n = 1, 5.3%). cUIAs were located at the distal internal carotid artery (n = 9, 39.1%), anterior cerebral artery (n = 8, 34.8%), middle cerebral artery (n = 4, 17.4%), basilar artery top (n = 1, 4.3%), and posterior cerebral artery, P1 segment (n = 1, 4.3%). The outcomes of preoperative coiling of cUIA and subsequent brain tumor surgery were retrospectively evaluated.ResultsSingle-microcatheter technique was used in 13 cases (56.5%), balloon-assisted in 4 cases (17.4%), double-microcatheter in 4 cases (17.4%), and stent-assisted in 2 cases (8.7%). Complete cUIA occlusion was achieved in 18 cases (78.3%), while residual neck occurred in 5 cases (21.7%). The only coiling-related complication was 1 transient ischemic attack (5.3%). Neurological deterioration did not occur in any patient during the period between coiling and tumor surgery. At the latest clinical follow-up (mean, 29 months; range, 2–120 months), 15 patients (78.9%) had favorable outcomes (modified Rankin Scale, 0–2), while 4 patients (21.1%) had unfavorable outcomes due to consequences of brain tumor surgery.ConclusionPreoperative coiling and subsequent tumor surgery was safe and effective, making it a reasonable treatment option for patients with brain tumor and cUIA.

show abstract

Pipeline Embolization Device for Large/Giant or Fusiform Aneurysms: An Initial Multi-Center Experience in Korea

Cited by 34 publications

References 23 publications

Aneurysms with persistent filling after failed treatment with the Pipeline embolization device

Aneurysms with persistent filling after failed treatment with the Pipeline embolization device

The Evolution of Flow-Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction

Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery

Contact Info

Product

Resources

About