Utilization of Pipeline embolization device for treatment of ruptured intracranial aneurysms

US multicenter experience

Ning Lin, Adam M. Brouillard, Kiffon M. Keigher, Demetrius K. Lopes, Mandy J. Binning, Kenneth M. Liebman, Erol Veznedaroglu, Jordan A. Magarik, J. Mocco, Edward A. Duckworth, Adam Arthur, Andrew J. Ringer, Kenneth V. Snyder, Elad I. Levy, Adnan H. Siddiqui

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Objective Utilization of the Pipeline embolization device (PED) in complex ruptured aneurysms has not been well studied. We evaluated the safety and effectiveness data from five participating US centers. Methods Records of patients with ruptured cerebral aneurysms who underwent PED treatment between 2011 and 2013 were retrospectively reviewed. Results 26 patients with ruptured aneurysms underwent PED treatment (mean age 51.4 ±13.2 years;16 women). At presentation, 8 patients (30.8%) had a Hunt-Hess grade of IV or above; 11 required extraventricular drain placement. Aneurysm morphologies were: 8 dissecting, 8 blister-like, 6 fusiform, and 4 saccular. There were 22 anterior circulation and 4 posterior circulation aneurysms. PED deployment was successful in all patients, with adjunctive coiling utilized in 12. Periprocedural complications occurred in 5 (19.2%), including 3 inhospital deaths. 23 patients (88.5%) had postoperative angiography at a mean of 5.9 months: 18 aneurysms (78.3%) were completely occluded, 3 (13.0%) had residual neck filling, and 2 (8.7%) had residual dome filling. All blister-type aneurysms were completely occluded at follow-up. Clinical follow-up was available for an average of 10.1 months (range 2-21 months), with one asymptomatic in-stent stenosis and one asymptomatic thromboembolic stroke noted. Good outcome (modified Rankin Scale (MRS) score of 0-2) was achieved in 20 patients (76.9%), fair (MRS 3-4) in 3 (11.5%), and 3 died (11.5%). Conclusions The PED can be utilized for ruptured aneurysms and is a good option for blister-type aneurysms. However, due to periprocedural complications, it should be reserved for lesions that are difficult to treat by conventional clipping or coiling.

Original languageEnglish (US)
Pages (from-to)808-815
Number of pages8
JournalJournal of neurointerventional surgery
Volume7
Issue number11
DOIs
StatePublished - Nov 1 2015

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Ruptured Aneurysm
Intracranial Aneurysm
Aneurysm
Equipment and Supplies
Blister
Therapeutics
Stents
Angiography
Pathologic Constriction
Neck
Stroke
Safety

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Lin, N., Brouillard, A. M., Keigher, K. M., Lopes, D. K., Binning, M. J., Liebman, K. M., ... Siddiqui, A. H. (2015). Utilization of Pipeline embolization device for treatment of ruptured intracranial aneurysms: US multicenter experience. Journal of neurointerventional surgery, 7(11), 808-815. https://doi.org/10.1136/neurintsurg-2014-011320

Utilization of Pipeline embolization device for treatment of ruptured intracranial aneurysms : US multicenter experience. / Lin, Ning; Brouillard, Adam M.; Keigher, Kiffon M.; Lopes, Demetrius K.; Binning, Mandy J.; Liebman, Kenneth M.; Veznedaroglu, Erol; Magarik, Jordan A.; Mocco, J.; Duckworth, Edward A.; Arthur, Adam; Ringer, Andrew J.; Snyder, Kenneth V.; Levy, Elad I.; Siddiqui, Adnan H.

In: Journal of neurointerventional surgery, Vol. 7, No. 11, 01.11.2015, p. 808-815.

Research output: Contribution to journalArticle

Lin, N, Brouillard, AM, Keigher, KM, Lopes, DK, Binning, MJ, Liebman, KM, Veznedaroglu, E, Magarik, JA, Mocco, J, Duckworth, EA, Arthur, A, Ringer, AJ, Snyder, KV, Levy, EI & Siddiqui, AH 2015, 'Utilization of Pipeline embolization device for treatment of ruptured intracranial aneurysms: US multicenter experience', Journal of neurointerventional surgery, vol. 7, no. 11, pp. 808-815. https://doi.org/10.1136/neurintsurg-2014-011320
Lin, Ning ; Brouillard, Adam M. ; Keigher, Kiffon M. ; Lopes, Demetrius K. ; Binning, Mandy J. ; Liebman, Kenneth M. ; Veznedaroglu, Erol ; Magarik, Jordan A. ; Mocco, J. ; Duckworth, Edward A. ; Arthur, Adam ; Ringer, Andrew J. ; Snyder, Kenneth V. ; Levy, Elad I. ; Siddiqui, Adnan H. / Utilization of Pipeline embolization device for treatment of ruptured intracranial aneurysms : US multicenter experience. In: Journal of neurointerventional surgery. 2015 ; Vol. 7, No. 11. pp. 808-815.
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abstract = "Objective Utilization of the Pipeline embolization device (PED) in complex ruptured aneurysms has not been well studied. We evaluated the safety and effectiveness data from five participating US centers. Methods Records of patients with ruptured cerebral aneurysms who underwent PED treatment between 2011 and 2013 were retrospectively reviewed. Results 26 patients with ruptured aneurysms underwent PED treatment (mean age 51.4 ±13.2 years;16 women). At presentation, 8 patients (30.8{\%}) had a Hunt-Hess grade of IV or above; 11 required extraventricular drain placement. Aneurysm morphologies were: 8 dissecting, 8 blister-like, 6 fusiform, and 4 saccular. There were 22 anterior circulation and 4 posterior circulation aneurysms. PED deployment was successful in all patients, with adjunctive coiling utilized in 12. Periprocedural complications occurred in 5 (19.2{\%}), including 3 inhospital deaths. 23 patients (88.5{\%}) had postoperative angiography at a mean of 5.9 months: 18 aneurysms (78.3{\%}) were completely occluded, 3 (13.0{\%}) had residual neck filling, and 2 (8.7{\%}) had residual dome filling. All blister-type aneurysms were completely occluded at follow-up. Clinical follow-up was available for an average of 10.1 months (range 2-21 months), with one asymptomatic in-stent stenosis and one asymptomatic thromboembolic stroke noted. Good outcome (modified Rankin Scale (MRS) score of 0-2) was achieved in 20 patients (76.9{\%}), fair (MRS 3-4) in 3 (11.5{\%}), and 3 died (11.5{\%}). Conclusions The PED can be utilized for ruptured aneurysms and is a good option for blister-type aneurysms. However, due to periprocedural complications, it should be reserved for lesions that are difficult to treat by conventional clipping or coiling.",
author = "Ning Lin and Brouillard, {Adam M.} and Keigher, {Kiffon M.} and Lopes, {Demetrius K.} and Binning, {Mandy J.} and Liebman, {Kenneth M.} and Erol Veznedaroglu and Magarik, {Jordan A.} and J. Mocco and Duckworth, {Edward A.} and Adam Arthur and Ringer, {Andrew J.} and Snyder, {Kenneth V.} and Levy, {Elad I.} and Siddiqui, {Adnan H.}",
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T1 - Utilization of Pipeline embolization device for treatment of ruptured intracranial aneurysms

T2 - US multicenter experience

AU - Lin, Ning

AU - Brouillard, Adam M.

AU - Keigher, Kiffon M.

AU - Lopes, Demetrius K.

AU - Binning, Mandy J.

AU - Liebman, Kenneth M.

AU - Veznedaroglu, Erol

AU - Magarik, Jordan A.

AU - Mocco, J.

AU - Duckworth, Edward A.

AU - Arthur, Adam

AU - Ringer, Andrew J.

AU - Snyder, Kenneth V.

AU - Levy, Elad I.

AU - Siddiqui, Adnan H.

PY - 2015/11/1

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N2 - Objective Utilization of the Pipeline embolization device (PED) in complex ruptured aneurysms has not been well studied. We evaluated the safety and effectiveness data from five participating US centers. Methods Records of patients with ruptured cerebral aneurysms who underwent PED treatment between 2011 and 2013 were retrospectively reviewed. Results 26 patients with ruptured aneurysms underwent PED treatment (mean age 51.4 ±13.2 years;16 women). At presentation, 8 patients (30.8%) had a Hunt-Hess grade of IV or above; 11 required extraventricular drain placement. Aneurysm morphologies were: 8 dissecting, 8 blister-like, 6 fusiform, and 4 saccular. There were 22 anterior circulation and 4 posterior circulation aneurysms. PED deployment was successful in all patients, with adjunctive coiling utilized in 12. Periprocedural complications occurred in 5 (19.2%), including 3 inhospital deaths. 23 patients (88.5%) had postoperative angiography at a mean of 5.9 months: 18 aneurysms (78.3%) were completely occluded, 3 (13.0%) had residual neck filling, and 2 (8.7%) had residual dome filling. All blister-type aneurysms were completely occluded at follow-up. Clinical follow-up was available for an average of 10.1 months (range 2-21 months), with one asymptomatic in-stent stenosis and one asymptomatic thromboembolic stroke noted. Good outcome (modified Rankin Scale (MRS) score of 0-2) was achieved in 20 patients (76.9%), fair (MRS 3-4) in 3 (11.5%), and 3 died (11.5%). Conclusions The PED can be utilized for ruptured aneurysms and is a good option for blister-type aneurysms. However, due to periprocedural complications, it should be reserved for lesions that are difficult to treat by conventional clipping or coiling.

AB - Objective Utilization of the Pipeline embolization device (PED) in complex ruptured aneurysms has not been well studied. We evaluated the safety and effectiveness data from five participating US centers. Methods Records of patients with ruptured cerebral aneurysms who underwent PED treatment between 2011 and 2013 were retrospectively reviewed. Results 26 patients with ruptured aneurysms underwent PED treatment (mean age 51.4 ±13.2 years;16 women). At presentation, 8 patients (30.8%) had a Hunt-Hess grade of IV or above; 11 required extraventricular drain placement. Aneurysm morphologies were: 8 dissecting, 8 blister-like, 6 fusiform, and 4 saccular. There were 22 anterior circulation and 4 posterior circulation aneurysms. PED deployment was successful in all patients, with adjunctive coiling utilized in 12. Periprocedural complications occurred in 5 (19.2%), including 3 inhospital deaths. 23 patients (88.5%) had postoperative angiography at a mean of 5.9 months: 18 aneurysms (78.3%) were completely occluded, 3 (13.0%) had residual neck filling, and 2 (8.7%) had residual dome filling. All blister-type aneurysms were completely occluded at follow-up. Clinical follow-up was available for an average of 10.1 months (range 2-21 months), with one asymptomatic in-stent stenosis and one asymptomatic thromboembolic stroke noted. Good outcome (modified Rankin Scale (MRS) score of 0-2) was achieved in 20 patients (76.9%), fair (MRS 3-4) in 3 (11.5%), and 3 died (11.5%). Conclusions The PED can be utilized for ruptured aneurysms and is a good option for blister-type aneurysms. However, due to periprocedural complications, it should be reserved for lesions that are difficult to treat by conventional clipping or coiling.

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