The pipeline embolization device for the intracranial treatment of aneurysms trial.

Neurointerventional Service, Department of Radiology, NYU Langone Medical Center, New York, New York, USA.
American Journal of Neuroradiology (Impact Factor: 3.17). 01/2011; 32(1):34-40. DOI: 10.3174/ajnr.A2421
Source: PubMed

ABSTRACT Endoluminal reconstruction with flow diverting devices represents a novel constructive technique for the treatment of cerebral aneurysms. We present the results of the first prospective multicenter trial of a flow-diverting construct for the treatment of intracranial aneurysms.
Patients with unruptured aneurysms that were wide-necked (> 4 mm), had unfavorable dome/neck ratios (<1.5), or had failed previous therapy were enrolled in the PITA trial between January and May 2007 at 4 (3 European and 1 South American) centers. Aneurysms were treated with the PED with or without adjunctive coil embolization. All patients underwent clinical evaluation at 30 and 180 days and conventional angiography 180 days after treatment. Angiographic results were adjudicated by an experienced neuroradiologist at a nonparticipating site.
Thirty-one patients with 31 intracranial aneurysms (6 men; 42-76 years of age; average age, 54.6 years) were treated during the study period. Twenty-eight aneurysms arose from the ICA (5 cavernous, 15 parophthalmic, 4 superior hypophyseal, and 4 posterior communicating segments), 1 from the MCA, 1 from the vertebral artery, and 1 from the vertebrobasilar junction. Mean aneurysm size was 11.5 mm, and mean neck size was 5.8 mm. Twelve (38.7%) aneurysms had failed (or recurred after) a previous endovascular treatment. PED placement was technically successful in 30 of 31 patients (96.8%). Most aneurysms were treated with either 1 (n = 18) or 2 (n = 11) PEDs. Fifteen aneurysms (48.4%) were treated with a PED alone, while 16 were treated with both PED and embolization coils. Two patients experienced major periprocedural stroke. Follow-up angiography demonstrated complete aneurysm occlusion in 28 (93.3%) of the 30 patients who underwent angiographic follow-up. No significant in-construct stenosis (≥ 50%) was identified at follow-up angiography.
Intracranial aneurysm treatment with the PED is technically feasible and can be achieved with a safety profile analogous to that reported for stent-supported coil embolization. PED treatment elicited a very high rate (93%) of complete angiographic occlusion at 6 months in a population of the most challenging anatomic subtypes of cerebral aneurysms.

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    ABSTRACT: Background: Large size, and location in posterior circulation, both individually portend high risk in the endovascular management of intracranial aneurysms. Aim: The purpose of this study was to investigate the outcome of endovascular management of giant posterior circulation aneurysms at our centre. Materials and Methods: This is a retrospective analysis of 22 consecutive patients with giant posterior circulation aneurysms, who were managed by endovascular techniques between 1997 and 2009. The aneurysms included: Vertebral-6 (27%), basilar or vertebrobasilar - 7 (32%) and nine posterior cerebral artery (PCA) - 9 (41%). Results: There were 14 males and eight females with a mean age of 37 years. Treatment modalities included: Parent vessel sacrifice (PVS), coil embolization, flow reversal, stent-assisted coiling, and telescopic stent placement. Angiographic cure or stasis was achieved in 21 (95%) patients and no recurrence was observed in 17 of the 18 patients who had follow-up. Complications occurred in 9 (41%) patients, death in 4 and morbidity in 5 (3 with good eventual outcome). Overall, good clinical outcome was noted in 16 (73%) patients. The majority of the poor outcomes were observed in the management of basilar/vertebrobasilar aneurysms and flow reversal. Parent vessel sacrifice showed the best outcomes with stable results. Conclusions: Our results suggest that PVS remains the procedure of choice wherever possible and is relatively safe, particularly for giant vertebral and PCA aneurysms. When PVS is not feasible, stent-assisted coiling is a reasonable and safe option and requires follow-up. Management of basilar or vertebrobasilar aneurysms is complicated and still evolving.
    Neurology India 60(6):597-603. · 1.04 Impact Factor
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    ABSTRACT: OBJECTIVE: Pipeline Embolization Device (PED) implantation is a novel endovascular treatment option for intracranial aneurysms. It is emerging as a useful alternative to coiling and to open surgery and its use is increasing worldwide. We have performed a literature review to examine its efficacy, technical challenges and safety. METHOD: Pubmed database was used to identify all articles relating to PED. RESULT: The review outlines the indications for PED, its technical aspects, complications and clinical outcomes. CONCLUSION: PED offers an alternative to endovascular coiling for aneurysms with complex morphology. The indication for its use has evolved from the limited scope of treatment of giant aneurysms with wide necks, to the inclusion of smaller aneurysms. The procedural safety profile of PED is comparable or possibly superior to balloon-remodeling or stent-assisted coil embolization in specific circumstances. However, questions remain regarding the incidence of post-procedural subarachnoid hemorrhage. Ongoing monitoring and meticulous documentation of PED post-implantation safety is strongly recommended.
    World Neurosurgery 10/2012; · 1.77 Impact Factor
  • Journal of Neuroradiology 03/2014; · 1.24 Impact Factor

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