Use of concentric Solitaire stent to anchor Pipeline flow diverter constructs in treatment of shallow cervical carotid dissecting pseudoaneurysms

Rahal, Jason P.; Dandamudi, Venkata S.; Heller, Robert S.; Safain, Mina G.; Malek, Adel M.

doi:10.1016/j.jocn.2013.10.017

Cited by 23 publications

(21 citation statements)

References 16 publications

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“…The authors justified the use of the overlapping Solitaire stent by the hypothesis that the PED might have an accentuated tendency to migrate in a mobile cervical carotid artery. The authors described that, in both patients, the PEDs migrated up to 3.3 mm distally as early as 2 weeks after deployment, even with the use of the anchoring overlapping stent 23. Intracranial migration of a PED has previously been described in the literature and appears to be relatively infrequent 19 24 25.…”

Section: Discussionmentioning

confidence: 84%

“…Rahal et al 23 reported a case series of two patients with cervical carotid artery dissections with associated pseudoaneurysms treated with PEDs with overlapping Solitaire stents to prevent the migration of the stent. Both patients had complete revascularization of the treated artery and complete occlusion of the pseudoaneurysms on follow-up CTA.…”

Section: Discussionmentioning

confidence: 99%

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

Brzezicki

Rivet

Reavey‐Cantwell

2015

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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

Brzezicki

Rivet

Reavey‐Cantwell

2015

J NeuroIntervent Surg

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“…In addition, aggressive wire manipulation with a Synchro-2, 0.014-inch guidewire with a J-shaped distal tip was performed to maximally dilate the proximal stent construct. In addition to the strategies described here, Rahal et al [58] described a method of anchoring the PED construct by using a 6 × 30 mm Solitaire FR detachable stent (ev3 Neurovascular) in a successful treatment of 2 patients with extracranial dissections. PEDs are designed to open approximately 0.25 mm beyond their nominal diameter, such that the largest presently available diameter would be around 5.25 mm.…”

Section: Discussionmentioning

confidence: 99%

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

Amuluru¹,

Al‐Mufti²,

Roth

et al. 2017

Intervent Neurol

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Background: Traumatic extracranial internal carotid artery (ICA) dissections are uncommon and can be difficult to treat. 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. 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%. Endovascular intervention is indicated with failure of medical therapy, progressive enlargement of a traumatic pseudoaneurysm, acute flow-related infarcts due to vessel occlusion, or when anticoagulation is contraindicated due to risk of pseudoaneurysm rupture and hemorrhage. Recognized interventional treatments include parent artery occlusion with or without revascularization, endovascular coil embolization, and covered stenting. Summary: A wide variety of endovascular stents are available that are capable of opening a stenosed vessel while obliterating the associated false lumen and providing a scaffold for embolization of the pseudoaneurysm. The use of the Pipeline Embolization Device (PED) in the management of traumatic intracranial pseudoaneurysms has been described. However, there are few reports on the usage of the PED for treating traumatic extracranial ICA dissection and/ or pseudoaneurysms. However, a potential complication of the use of PED in the extracranial ICA is a hypothetical tendency to migrate in a mobile vessel. Thus, the risk of migration of the PED has encouraged practitioners to adopt strategies to limit this risk. Key Messages: We describe different techniques employed to anchor the flow-diverting construct within tortuous, mobile vessels.

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“…The term endoleak has recently been introduced into the intracranial and extracranial carotid stenting literature 23 24. Treatment via either prophylactic coiling of associated branches or post-treatment telescopic stenting has been proposed 23.…”

Section: Discussionmentioning

confidence: 99%

Failure of aneurysm occlusion by flow diverter: a role for surgical bypass and parent artery occlusion

Mattingly

Adel

Dyer

et al. 2014

J NeuroIntervent Surg

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Flow diverters represent a paradigm shift in the treatment of aneurysms. However, unusual and poorly understood complications are being reported. We present a case of a giant internal carotid artery terminus aneurysm treated with flow diversion that progressively and symptomatically enlarged despite a reduction in the filling portion. Complete occlusion of the aneurysm and reduction in mass effect occurred through superficial temporal artery- middle cerebral artery bypass and parent artery occlusion. Incomplete aneurysm occlusion following flow diversion has been reported, but mechanisms and predisposing factors are speculative and definitive solutions have not been described. This case illustrates a potential solution.

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Use of concentric Solitaire stent to anchor Pipeline flow diverter constructs in treatment of shallow cervical carotid dissecting pseudoaneurysms

Cited by 23 publications

References 16 publications

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

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

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

Failure of aneurysm occlusion by flow diverter: a role for surgical bypass and parent artery occlusion

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