Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series

Abstract

Our initial experience with treatment of high cervical and skull base dissections with the PED appears to show that this technique may be a safe and viable treatment option. However, long-term results are needed to fully evaluate the efficacy of such treatment.

Off-label uses of the Pipeline embolization device: a review of the literature

“…In another study, 13 dissections presented in 11 patients, and of the 13 dissections, 11 were associated with pseudoaneurysms (discussed in further detail in the next section, Pseudoaneurysms). 6 There was 1 nonsignificant procedure-related complication, and the complete occlusion rate at most recent follow-up was 75%. Other small series and case reports also presented favorable outcomes when using PED therapy for the treatment of dissecting aneurysms.…”

Anchoring Pipeline Flow Diverter Construct in the Treatment of Traumatic Distal Cervical Carotid Artery Injury

“…Medical management of cervical ICA dissections with anticoagulation or antiplatelet therapy yields good clinical outcomes in 70% of cases, with a reported complete recanalization rate of 51.4% [3,35] . However, in a subset of patients, the dissection will progress despite optimal medical therapy.…”

“…In addition to flow-limiting stenosis and embolic artery-to-artery phenomena, traumatic arterial dissection can lead to pseudoaneurysm formation in up to 86% of patients [3] . Additionally, the development of a traumatic ICA pseudoaneurysm carries a reported incidence of 1.2-2.7% in all patients with blunt or penetrating trauma of the neck [19][20][21][22][23][24][25][26][27] .…”

“…Stent reconstruction of dissections involving the petrous segment of the carotid artery is challenging due to the abrupt angulation of the vessel, which is fixed by the osseous skull base. Although the use of the PED in the management of traumatic intracranial pseudoaneurysms has been described, there are few reports on the usage of the PED for treating traumatic extracranial ICA dissections and/or pseudoaneurysms [1,3,12] .…”

“…Thinning of adventitia and dilatation may occur following arterial dissection, thus resulting in a fusiform pseudoaneurysm, which can subsequently cause bleeding, expanding or pulsatile hematoma, dysphagia, hoarseness, or hypotension [2] . Currently, medical management with anticoagulation remains the first line of treatment and yields good outcomes in 75% of cases with a mortality rate of 3-4% [3] .…”