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 HowingtonRobert Mericle, J. Mocco, Robert Replogle, Howard Riina, Rafael Rodriguez, Erol Veznedaroglu

Research output: Contribution to journalArticle

53 Scopus citations

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

    Fingerprint

Keywords

  • Clinical outcomes
  • Humans
  • Pipeline embolization
  • Retrospective studies
  • Ruptured aneurysm
  • Stents
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Yoon, J. W., Siddiqui, A. H., Dumont, T. M., Levy, E. I., Hopkins, L. N., Lanzino, G., Lopes, D. K., Moftakhar, R., Billingsley, J. T., Welch, B. G., Boulos, A. S., Yamamoto, J., Tawk, R. G., Ringer, A. J., Hanel, R. A., Arthur, A., Bendok, B., Fessler, R., Guterman, L., ... 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