Pipeline for previously stented basilar trunk aneurysm: a case focusing on how the pipeline should be deployed

Liang, Fei; Zhang, Yupeng; Di, Yuntao; Guo, Feng; Jiang, Chuhan

doi:10.1186/s41016-018-0134-7

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…Since craniotomy clipping is very difficult, EVT remains the first procedure of choice for BA trunk aneurysms ( 14 ). In the current choices for EVT, the flow-diverting stent has been widely used in cerebral aneurysms ( 2 , 15 ). However, the flow-diverting stent is rarely used for BA trunk aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Therapy for Basilar Arterial Trunk Aneurysms

Wang

Song

et al. 2021

Front. Neurol.

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Background: Although aneurysms rarely occur in the basilar artery (BA) trunk, the majority of those that do are dissection aneurysms. Currently, the mainstream therapy for BA trunk aneurysms is endovascular therapy (EVT), which mainly includes single coiling or conventional low-metal-coverage stent-assisted EVT, but the efficacy remains to be evaluated.Methods: A retrospective study was performed for the patients who were admitted to our institution for BA trunk aneurysms and underwent EVT. A total of 28 patients were collected in this study.Results: The patients were aged 23–71 years (53.7 ± 11.5 years on average); nine were female (32.1%, 9/28), and 19 were male (67.9%, 19/28). The patients were given single coiling or conventional low-metal-coverage stent-assisted EVT. Among the 28 patients, 10 (35.7%, 10/28) developed complications, 90% (9/10) of which were ischemic and 10% (1/10) were hemorrhagic. Among the 28 patients, 5 (17.9%, 5/28) died. The surviving 23 patients (82.1%, 23/28) recovered well.Conclusions: This study found that for BA trunk aneurysms, single coiling or conventional low-metal-coverage stent-assisted EVT still had some risks. The risks are mainly from brainstem ischemia. Therefore, the perforators of the BA trunk must be carefully evaluated and prevented from receiving damage from the EVT procedure. This study also shows that 82.1% of patients recovered well. Therefore, EVT can result in an acceptable prognosis.

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Section: Discussionmentioning

confidence: 99%

Endovascular Therapy for Basilar Arterial Trunk Aneurysms

Wang

Song

et al. 2021

Front. Neurol.

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“…Some studies reported procedural events related to implanting PED in a previous stent, with no corresponding scheme provided to avoid these technical difficulties (6, 13). The strategy to deploy the PED remains controversial (5,13,14). There are four types of overlap between a newly implanted PED and a previously deployed stent: (1) PED only covers the proximal end of the previous stent, (2) PED only covers the distal end of the previous stent, (3) PED covers both the proximal and distal ends of the previous stent, and (4) PED is deployed within the previous stent.…”

Section: Discussionmentioning

confidence: 99%

“…Chalouhi et al ( 5) deployed the PED within the indwelling stent or ensured sufficient PED length to anchor on the normal artery distally and proximally to the stent in situ. On the contrary, Liang et al (13) deemed to deploy the PED within the indwelling stent, that is to say, placing the proximal and distal ends of the FD device within the previous stent so that the PED would not be stuck at the struts of the previous stent. This resembled the FRED flow diverter, which has the additional benefit of lowering postprocedural ischemia (15).…”

Section: Discussionmentioning

confidence: 99%

Retreatment with a pipeline embolization device for recanalized aneurysms following stent-assisted coiling embolization

Ling,

Liu,

Zhou

et al. 2023

Front. Neurol.

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Background and purposeFlow diverters have emerged as viable alternatives for the retreatment of recanalized aneurysms following stent-assisted coiling embolization. In this study, we aim to present our experience of retreatment for such aneurysms using the pipeline embolization device (PED).Materials and methodsThis case series presents a retrospective single-center analysis of patients with recanalized aneurysms who underwent retreatment using the PED between July 2019 and April 2023, subsequent to stent-assisted coiling embolization.ResultsThe study includes five female patients, whose relevant clinical data were recorded. All patients had aneurysms located in the internal carotid artery, comprising two blood blister-like aneurysms and two giant aneurysms. Prior to the retreatment, two LVIS stents, two enterprise stents, and one solitaire stent were implanted. Among the five patients, one experienced a fatal post-operative subarachnoid hemorrhage, while two patients achieved complete embolization, and another patient achieved near-complete embolization during the last follow-up. Furthermore, one patient faced challenges during the placement of the PED and was unable to achieve successful deployment. We propose four overlapping relationships between a newly implanted PED and a previously deployed stent: (1) PED covering only the proximal end of the previous stent, (2) PED covering only the distal end of the previous stent, (3) PED covering both the proximal and distal ends of the previous stent, and (4) PED deployed within the previous stent. Antiplatelet therapy at our center involved daily dual therapy with aspirin (100 mg/day) and clopidogrel (75 mg/day) for at least 5 days before PED placement. Intra-arterial bolus administration of tirofiban (5 mcg/kg) was administered during or immediately after PED deployment, followed by a maintenance dose of 0.08 mcg/kg/min IV infusion for at least 24–48 h if necessary. Postprocedural dual antiplatelet therapy included clopidogrel (75 mg/day) for 6 months and aspirin (100 mg/day) for 12 months.ConclusionThe findings of this study support the efficacy of the PED for the retreatment of recanalized aneurysms following stent-assisted coiling embolization.

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Pipeline for previously stented basilar trunk aneurysm: a case focusing on how the pipeline should be deployed

Cited by 2 publications

References 11 publications

Endovascular Therapy for Basilar Arterial Trunk Aneurysms

Endovascular Therapy for Basilar Arterial Trunk Aneurysms

Retreatment with a pipeline embolization device for recanalized aneurysms following stent-assisted coiling embolization

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