Pipeline Embolization Device for the Treatment of Ruptured Intracerebral Aneurysms: A Multicenter Retrospective Study

Zhong, Weiying; Kuang, Hong; Zhang, Ping; Yang, Xinjian; Luo, Bin; Maimaitili, Aisha; Zhao, Yuanli; Song, Dong Ho; Guan, Sheng; Zhang, Hongqi; Wang, Yang; Wang, Donghai; Su, Wandong; Wang, Yunyan

doi:10.3389/fneur.2021.675917

Cited by 9 publications

(7 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Endovascular SAC therapy is typically more frequently used than FD in wide-neck ruptured cerebral aneurysms due to the increased risk of periprocedural bleeding and ischemic complications from using FD in ruptured aneurysms, especially in the acute phase. 33 However, Bechan et al showed the rate of short-term complications from SAC in ruptured aneurysms was ten times higher than in unruptured aneurysms. 11 A higher complication rate was related to ruptured aneurysm treatment.…”

Section: Discussionmentioning

confidence: 98%

Treatment of Wide-Neck Intracranial Aneurysm: Current Concepts and Endovascular Approach

Kurniawan

Prasetyo²,

Rilianto³

et al. 2023

AKSONA

View full text Add to dashboard Cite

Highlight: Endovascular treatment is recommended for aneurysms Wide-neck aneurysm is difficult to treat with endovascular approach. Stent-assisted coiling and flow diverter are choices for wide-neck aneurysms ABSTRACT A wide-neck aneurysm, described as an aneurysm with a neck of 4 mm or a dome-to-neck ratio of <2, requires more advanced endovascular treatment than a narrow-neck aneurysm. Stent-assisted coiling (SAC) was the sole endovascular approach for wide-neck cerebral aneurysms, which were difficult to treat surgically or by embolization. More advanced endovascular approaches have since been developed in recent years, namely the flow diverter (FD) as an endovascular treatment for wide-neck cerebral aneurysms with an endoluminal reconstruction approach. Both techniques have advantages and disadvantages that must be studied further to develop a wide-neck cerebral aneurysm therapy. Therefore, based on the current literature, this article intends to review the differences in the efficacy and complications of SAC and FD for wide-neck aneurysm therapy.

show abstract

Section: Discussionmentioning

confidence: 98%

Treatment of Wide-Neck Intracranial Aneurysm: Current Concepts and Endovascular Approach

Kurniawan

Prasetyo²,

Rilianto³

et al. 2023

AKSONA

View full text Add to dashboard Cite

show abstract

“…An analysis of outcomes for the other main treatment options for complex intracranial aneurysms highlights the significant challenges of managing this patient population. Flow diversion is the main endovascular option for the treatment of nonsaccular ruptured aneurysms, but is associated with a 21 to 26% rate of ischemic/hemorrhagic complications with use of either standard devices and dual anti-platelet regimens, or newer devices and single agent anti-platelets across all anatomic sites (4,5). While good neurologic outcomes have been reported with flow diversion for the treatment of fusiform VA aneurysms involving the PICA origin (representing 50% of the cases in the series), complete aneurysm occlusion occurs in <60% of cases, while PICA/VA occlusion can occur in up to 10% of cases (47).…”

Section: Discussionmentioning

confidence: 99%

“…Intrasaccular devices similarly have the potential to change treatment paradigms for selected widenecked saccular aneurysms (2). Limitations to these technologies nonetheless exist, particularly in the setting of ruptured aneurysms where flow diversion (or stent/coil constructs) requires the use of dual anti-platelet agents (increasing the risk of hemorrhage with ventricular catheters), and both flow diversion and intrasaccular devices can often have continued aneurysm filling (maintaining a small but significant risk of re-rupture) (3,4). Although newer flow diversion technologies are being investigated that require only a single anti-platelet agent, concerns regarding significant morbidity and mortality from ischemic complications or post-treatment aneurysmal re-bleeding (occurring in up to 21% of patients) remain based on data from preliminary studies (5).…”

Section: Introductionmentioning

confidence: 99%

Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series

et al. 2023

View full text Add to dashboard Cite

Background and purposeThe treatment of complex intracranial aneurysms can be challenging with stand-alone open or endovascular techniques, particularly after rupture. A combined open and endovascular strategy can potentially limit the risk of extensive dissections with open-only techniques, and allow for aggressive definitive endovascular treatments with minimized downstream ischemic risk.Materials and methodsRetrospective, single-institution review of consecutive patients undergoing combined open revascularization and endovascular embolization/occlusion for complex intracranial aneurysms from 1/2016 to 6/2022.ResultsTen patients (4 male [40%]; mean age 51.9 ± 8.7 years) underwent combined open revascularization and endovascular treatment of intracranial aneurysms. The majority of aneurysms, 9/10 (90%), were ruptured and 8/10 (80%) were fusiform in morphology. Aneurysms of the posterior circulation represented 8/10 (80%) of the cases (vertebral artery [VA] involving the posterior inferior cerebellar artery [PICA] origin, proximal PICA or anterior inferior cerebellar artery/PICA complex, or proximal posterior cerebral artery). Revascularization strategies included intracranial-to-intracranial (IC-IC; 7/10 [70%]) and extracranial-to-intracranial (EC-IC; 3/10 [30%]) constructs, with 100% postoperative patency. Initial endovascular procedures (consisting of aneurysm/vessel sacrifice in 9/10 patients) were performed early after surgery (0.7 ± 1.5 days). In one patient, secondary endovascular vessel sacrifice was performed after an initial sub-occlusive embolization. Treatment related strokes were diagnosed in 3/10 patients (30%), largely from involved or nearby perforators. All bypasses with follow-up were patent (median 14.0, range 4–72 months). Good outcomes (defined as a Glasgow Outcomes Scale ≥4 and modified Rankin Scale ≤2) occurred in 6/10 patients (60%).ConclusionA variety of complex aneurysms not amenable to stand-alone open or endovascular techniques can be successfully treated with combined open and endovascular approaches. Recognition and preservation of perforators is critical to treatment success.

show abstract

“…10 Moreover, the stasis and the 3D scaffold-like coil design enable thrombus formation within the aneurysm to interfere with blood flow to the aneurysm wall, specifically the rupture site. 11 A study conducted by applying computational dynamics demonstrated that an FD combined with coiling considerably reduced the intraaneurysmal flow velocity and shear stress on the aneurysm wall compared to an FD alone, and further lowered the risk of aneurysm rupture and accelerated thrombosis. 12 Recent retrospective studies have also validated the benefit of this treatment strategy in lowering the risk of perioperative rebleeding.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of flow diverter combined with coil embolization and evidence-based antithrombotic regimen in the treatment of ruptured aneurysms

Chen

Gong

You

et al. 2023

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVE The use of a flow diverter (FD) in the treatment of ruptured aneurysms is limited due to the increased risk of perioperative ischemia and hemorrhagic complications. Adjunctive coil embolization and an evidence-based antithrombotic regimen may improve therapeutic safety, although evidence from relevant clinical research is limited. The authors’ aim was to further assess the perioperative safety and long-term efficacy of this strategy. METHODS Data on patients with FD insertion and coil embolization were collected retrospectively at two centers. The perioperative antithrombotic regimen consists of intraoperative tirofiban and continues for 24 hours postoperatively, with the initiation of an orally administered dual-antiplatelet regimen 4 hours prior to tirofiban cessation, rather than purposeful preoperative antiplatelet therapy. Perioperative cerebral ischemia and hemorrhagic complications and long-term aneurysm occlusion rates were recorded to evaluate the safety and efficacy of the procedure, respectively. RESULTS In total, 67 cases were screened and 41 cases were ultimately included in this study. A total of 2 cases (4.9%) of perioperative cerebral hemorrhagic events occurred, 1 of which (2.4%) was attributable to rerupture of the aneurysm. Cerebral ischemic events were reported in 3 patients, including 1 with cortical thromboembolism and 2 with perforator occlusion of the basilar artery. A median 8-month follow-up was attained in 25 patients (61.0%), with a 92% complete or near-complete occlusion rate. CONCLUSIONS FD insertion combined with coil embolization is a potentially safe and effective therapeutic strategy for ruptured aneurysms when accompanied with perioperative evidence-based antithrombotic therapy.

show abstract

Pipeline Embolization Device for the Treatment of Ruptured Intracerebral Aneurysms: A Multicenter Retrospective Study

Cited by 9 publications

References 36 publications

Treatment of Wide-Neck Intracranial Aneurysm: Current Concepts and Endovascular Approach

Treatment of Wide-Neck Intracranial Aneurysm: Current Concepts and Endovascular Approach

Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series

Efficacy and safety of flow diverter combined with coil embolization and evidence-based antithrombotic regimen in the treatment of ruptured aneurysms

Contact Info

Product

Resources

About