In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Twisting: Prevalence and Risk Factors of an Under-Reported Intra-Procedural Complication Associated with Pipeline Flow Diversion of Cerebral Aneurysms

    Final Number:
    1229

    Authors:
    Robert W.C. Young BS; Jessica K. Campos MD; Matthew Bender MD; Bowen Jiang MD; David A. Zarrin BS; Chau D. Vo BA; Justin M. Caplan MD; Judy Huang MD; Rafael Jesus Tamargo MD; Li-Mei Lin MD; Geoffrey P. Colby MD, PhD; Alexander L. Coon MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Pipeline Embolization Device twisting or torsion manifests with appearance of a “figure 8” in perpendicular planes on DSA. The prevalence of this intra-procedural complication has not been described.

    Methods: Case images were reviewed for instances of twisting from a prospectively-maintained, IRB-approved database of cerebral aneurysm patients undergoing flow diversion.

    Results: A total of 628 PED-Flex devices were used in 509 procedures on 438 patients and 19 instances of twisting were observed (prevalence 3.0%, 19/628). Twisting was most common in large, non-saccular aneurysms along the ICA. The average aneurysm size was 17mm (range 4-38 mm), morphology was fusiform or dissecting in 31%, and location was 13 ICA, 1 anterior communicating artery, and 2 mid-basilar artery. Larger diameter and longer devices are predisposed to twisting. Of the twisted devices, 89.5% (17/19) were =4.5mm diameter and 10.5% (2/19) were <4.5mm. The average length was 27.5 mm (range 16-35 mm). Of the 19 twisted devices, 13 were remediated and successfully deployed and six were removed (31.6%). Remediation maneuvers included resheathing and wagging the device. Balloon angioplasty facilitated opening in 3/16 cases and was used for post-processing in 6/19 cases. Procedural success was achieved in 15/16 cases and one procedure was aborted after twisting. One major complication (6%) was observed, a patient with mid-basilar aneurysm treated by PED who experienced perforator stroke that may have been related to incomplete device apposition. Occlusion outcomes were inferior to the overall PED population. Follow-up DSA was available for 62.5% (10/16); complete occlusion was observed in 44.4% (4/9) at 6 months, 50% (4/8) at 12 months, and 50% (5/10) at last follow-up.

    Conclusions: The prevalence of device twisting in a large series of PED-Flex deployments was 3.0%. Twisting is more common with large diameter devices. Remediation is challenging but can be accomplished to avoid clinical consequence.

    Patient Care: Improved understanding of the clinical ramifications of Pipeline Embolization Device twisting when treating cerebral aneurysms with flow diversion.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the prevalence of and associated risk factors for PED twisting, 2) Describe techniques for remediation, and 3) Describe clinical outcomes associated with PED twisting.

    References: ----

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy