Introduction: The use of the pipeline embolization device (PED) in the management of recurrent previously stented cerebral aneurysms has been controversial ever since early reports questioned its role in treating aneurysms with a previous stent placement. The aim of this study is to evaluate the efficacy and safety of the PED in the treatment of recurrent, previously stented aneurysms.
Methods: 16 patients with previously stented recurrent aneurysms who later underwent PED placement were retrospectively identified. Angiographic occlusion at the latest follow-up angiogram, recurrence and retreatment rates after PED placement and clinical outcomes were assessed. Safety was evaluated by analyzing the complications, morbidity and mortality observed after treatment with the PED.
Results: The mean patient age was 55 years. The mean time from stenting to angiographic recurrence was 25 months. PED treatment resulted in complete aneurysm occlusion in 50% of patients and near complete aneurysm occlusion (=90%) in 14.3%, for a total rate of complete and near complete aneurysm occlusion of 64.3%. 2 previously stented aneurysms that were managed with the PED required a second re-treatment (12.5%). 87.5% of patients had a good clinical outcome at the latest follow-up. Complications were observed in 12.5% of patients, both were thromboembolic complications. There were no mortalities.
Conclusions: The use of the PED in the management of previously stented cerebral aneurysms is less effective than the use of this device in non-stented aneurysms. Prior stent placement can worsen the safety and efficacy profile of the PED.
Patient Care: This paper will provide important data on the safety and efficacy of the pipeline embolization device in the management of recurrent cerebral aneurysms that were previously stented.
Learning Objectives: To look at the role of the pipeline embolization device in the management of recurrent previously stented aneurysms.
References: 1. Raymond J, Guilbert F, Weill A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke; a journal of cerebral circulation. Jun 2003;34(6):1398-1403.
2. Ferns SP, Sprengers ME, van Rooij WJ, et al. Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke; a journal of cerebral circulation. Aug 2009;40(8):e523-529.
3. Ries T, Siemonsen S, Thomalla G, et al. Long-term follow-up of cerebral aneurysms after endovascular therapy prediction and outcome of retreatment. AJNR. American journal of neuroradiology. Oct 2007;28(9):1755-1761.
4. Chalouhi N, Jabbour P, Singhal S, et al. Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke; a journal of cerebral circulation. May 2013;44(5):1348-1353.
5. Kallmes DF, Ding YH, Dai D, et al. A new endoluminal, flow-disrupting device for treatment of saccular aneurysms. Stroke; a journal of cerebral circulation. Aug 2007;38(8):2346-2352.
6. Fiorella D, Woo HH, Albuquerque FC, et al. Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery. May 2008;62(5):1115-1120; discussion 1120-1111.
7. D'Urso PI, Lanzino G, Cloft HJ, et al. Flow diversion for intracranial aneurysms: a review. Stroke; a journal of cerebral circulation. Aug 2011;42(8):2363-2368.
8. Zanaty M, Chalouhi N, Starke RM, et al. Flow diversion versus conventional treatment for carotid cavernous aneurysms. Stroke; a journal of cerebral circulation. Sep 2014;45(9):2656-2661.
9. Chalouhi N, Tjoumakaris S, Starke RM, et al. Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms. Stroke; a journal of cerebral circulation. Aug 2013;44(8):2150-2154.
10. Fischer S, Vajda Z, Aguilar Perez M, et al. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. Apr 2012;54(4):369-382.
11. Lylyk P, Miranda C, Ceratto R, et al. Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery. Apr 2009;64(4):632-642; discussion 642-633; quiz N636.
12. Nelson PK, Lylyk P, Szikora I, et al. The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR. American journal of neuroradiology. Jan 2011;32(1):34-40.
13. Chitale R, Gonzalez LF, Randazzo C, et al. Single center experience with pipeline stent: feasibility, technique, and complications. Neurosurgery. Sep 2012;71(3):679-691; discussion 691.
14. Brinjikji W, Murad MH, Lanzino G, et al. Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis. Stroke; a journal of cerebral circulation. Feb 2013;44(2):442-447.
15. Kallmes DF, Hanel R, Lopes D, et al. International Retrospective Study of the Pipeline Embolization Device: A Multicenter Aneurysm Treatment Study. AJNR. American journal of neuroradiology. Oct 29 2014.
16. Chalouhi N, Chitale R, Starke RM, et al. Treatment of recurrent intracranial aneurysms with the Pipeline Embolization Device. Journal of neurointerventional surgery. Jan 2014;6(1):19-23.