Feasibility and safety of pipeline embolization device in patients with ruptured carotid blister aneurysms

Jang W. Yoon, Adnan H. Siddiqui, Travis M. Dumont, Elad I. Levy, L. Nelson Hopkins, Giuseppe Lanzino, Demetrius K. Lopes, Roham Moftakhar, Joshua T. Billingsley, Babu G. Welch, Alan S. Boulos, Junichi Yamamoto, Rabih G. Tawk, Andrew J. Ringer, Ricardo A. Hanel, Adam Arthur, Bernard Bendok, Richard Fessler, Lee Guterman, Jay Howington & 6 others Robert Mericle, J. Mocco, Robert Replogle, Howard Riina, Rafael Rodriguez, Erol Veznedaroglu

Research output: Contribution to journalArticle

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Abstract

RESULTS: A total of 12 IC-RBAs in 11 patients were treated during the study period. Nine (75%) were treated with a single PED; 1 was treated with 2 PEDs; 1 was treated with coils and 1 PED; and 1 was treated with coils and 2 PEDs. Three (27%) had major perioperative complications: middle cerebral artery territory infarction, vision loss, and death. Seven patients demonstrated complete obliteration of the aneurysm in postoperative imaging. Early clinical outcomes were favorable (modified Rankin Scale score, 0-2) in all 10 survivors.

BACKGROUND: Treatment of internal carotid ruptured blister aneurysms (IC-RBA) presents many challenges to neurosurgeons because of the high propensity for rebleeding during intervention. The role of a Pipeline Embolization Device (PED) in the treatment of this challenging aneurysm subtype remains undefined despite theoretical advantages.

OBJECTIVE: To present a series of 11 patients treated with a PED and to discuss the management and results of this novel application of flow diverters.

METHODS: Medical records of patients who presented with IC-RBA from May 2011 to March 2013 were retrospectively reviewed at 6 institutions in the United States. All relevant data were independently compiled.

CONCLUSION: This study demonstrates the feasibility and safety of using the PED to treat IC-RBA with fair initial results. The proper introduction and management of antiplatelet regimen are key for successful results. Bleeding complications related to dual antiplatelet therapy were similar to those in previous studies of stent-assisted coiling for the same population. Larger cohort analysis is needed to define the precise role of flow diverters in the treatment of IC-RBA.

Original languageEnglish (US)
Pages (from-to)419-429
Number of pages11
JournalNeurosurgery
Volume75
Issue number4
DOIs
StatePublished - Jan 1 2014

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Blister
Ruptured Aneurysm
Aneurysm
Safety
Equipment and Supplies
Middle Cerebral Artery Infarction
Feasibility Studies
Therapeutics
Stents
Medical Records
Survivors
Cohort Studies
Hemorrhage
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Yoon, J. W., Siddiqui, A. H., Dumont, T. M., Levy, E. I., Hopkins, L. N., Lanzino, G., ... Veznedaroglu, E. (2014). Feasibility and safety of pipeline embolization device in patients with ruptured carotid blister aneurysms. Neurosurgery, 75(4), 419-429. https://doi.org/10.1227/NEU.0000000000000487

Feasibility and safety of pipeline embolization device in patients with ruptured carotid blister aneurysms. / Yoon, Jang W.; Siddiqui, Adnan H.; Dumont, Travis M.; Levy, Elad I.; Hopkins, L. Nelson; Lanzino, Giuseppe; Lopes, Demetrius K.; Moftakhar, Roham; Billingsley, Joshua T.; Welch, Babu G.; Boulos, Alan S.; Yamamoto, Junichi; Tawk, Rabih G.; Ringer, Andrew J.; Hanel, Ricardo A.; Arthur, Adam; Bendok, Bernard; Fessler, Richard; Guterman, Lee; Howington, Jay; Mericle, Robert; Mocco, J.; Replogle, Robert; Riina, Howard; Rodriguez, Rafael; Veznedaroglu, Erol.

In: Neurosurgery, Vol. 75, No. 4, 01.01.2014, p. 419-429.

Research output: Contribution to journalArticle

Yoon, JW, Siddiqui, AH, Dumont, TM, Levy, EI, Hopkins, LN, Lanzino, G, Lopes, DK, Moftakhar, R, Billingsley, JT, Welch, BG, Boulos, AS, Yamamoto, J, Tawk, RG, Ringer, AJ, Hanel, RA, Arthur, A, Bendok, B, Fessler, R, Guterman, L, Howington, J, Mericle, R, Mocco, J, Replogle, R, Riina, H, Rodriguez, R & Veznedaroglu, E 2014, 'Feasibility and safety of pipeline embolization device in patients with ruptured carotid blister aneurysms', Neurosurgery, vol. 75, no. 4, pp. 419-429. https://doi.org/10.1227/NEU.0000000000000487
Yoon, Jang W. ; Siddiqui, Adnan H. ; Dumont, Travis M. ; Levy, Elad I. ; Hopkins, L. Nelson ; Lanzino, Giuseppe ; Lopes, Demetrius K. ; Moftakhar, Roham ; Billingsley, Joshua T. ; Welch, Babu G. ; Boulos, Alan S. ; Yamamoto, Junichi ; Tawk, Rabih G. ; Ringer, Andrew J. ; Hanel, Ricardo A. ; Arthur, Adam ; Bendok, Bernard ; Fessler, Richard ; Guterman, Lee ; Howington, Jay ; Mericle, Robert ; Mocco, J. ; Replogle, Robert ; Riina, Howard ; Rodriguez, Rafael ; Veznedaroglu, Erol. / Feasibility and safety of pipeline embolization device in patients with ruptured carotid blister aneurysms. In: Neurosurgery. 2014 ; Vol. 75, No. 4. pp. 419-429.
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T1 - Feasibility and safety of pipeline embolization device in patients with ruptured carotid blister aneurysms

AU - Yoon, Jang W.

AU - Siddiqui, Adnan H.

AU - Dumont, Travis M.

AU - Levy, Elad I.

AU - Hopkins, L. Nelson

AU - Lanzino, Giuseppe

AU - Lopes, Demetrius K.

AU - Moftakhar, Roham

AU - Billingsley, Joshua T.

AU - Welch, Babu G.

AU - Boulos, Alan S.

AU - Yamamoto, Junichi

AU - Tawk, Rabih G.

AU - Ringer, Andrew J.

AU - Hanel, Ricardo A.

AU - Arthur, Adam

AU - Bendok, Bernard

AU - Fessler, Richard

AU - Guterman, Lee

AU - Howington, Jay

AU - Mericle, Robert

AU - Mocco, J.

AU - Replogle, Robert

AU - Riina, Howard

AU - Rodriguez, Rafael

AU - Veznedaroglu, Erol

PY - 2014/1/1

Y1 - 2014/1/1

N2 - RESULTS: A total of 12 IC-RBAs in 11 patients were treated during the study period. Nine (75%) were treated with a single PED; 1 was treated with 2 PEDs; 1 was treated with coils and 1 PED; and 1 was treated with coils and 2 PEDs. Three (27%) had major perioperative complications: middle cerebral artery territory infarction, vision loss, and death. Seven patients demonstrated complete obliteration of the aneurysm in postoperative imaging. Early clinical outcomes were favorable (modified Rankin Scale score, 0-2) in all 10 survivors.BACKGROUND: Treatment of internal carotid ruptured blister aneurysms (IC-RBA) presents many challenges to neurosurgeons because of the high propensity for rebleeding during intervention. The role of a Pipeline Embolization Device (PED) in the treatment of this challenging aneurysm subtype remains undefined despite theoretical advantages.OBJECTIVE: To present a series of 11 patients treated with a PED and to discuss the management and results of this novel application of flow diverters.METHODS: Medical records of patients who presented with IC-RBA from May 2011 to March 2013 were retrospectively reviewed at 6 institutions in the United States. All relevant data were independently compiled.CONCLUSION: This study demonstrates the feasibility and safety of using the PED to treat IC-RBA with fair initial results. The proper introduction and management of antiplatelet regimen are key for successful results. Bleeding complications related to dual antiplatelet therapy were similar to those in previous studies of stent-assisted coiling for the same population. Larger cohort analysis is needed to define the precise role of flow diverters in the treatment of IC-RBA.

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