Silent ischemic events after Pipeline embolization device: A prospective evaluation with MR diffusion-weighted imaging

Leonardo B C Brasiliense, Morgan A. Stanley, Sanjeet S. Grewal, Harry J. Cloft, Eric Sauvageau, Giuseppe Lanzino, David Miller, David F Kallmes, Ricardo Hanel

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

Background The development of ischemic events is relatively common after endovascular interventions, and flow diverters may pose a particular threat owing to their increased technical complexity and high metal content. Objective To investigate the incidence and potential risk factors for thromboembolic lesions after treatment with a Pipeline embolization device (PED). Methods This prospective study included a total of 59 patients electively treated with a PED over 12months. Postprocedural diffusion-weighted imaging sequences of the brain were obtained 24h after interventions to detect ischemic lesions. Demographic data, aneurysm characteristics, antiplatelet management, and perioperative data were correlated with the rate of ischemic events. Results The incidence of silent ischemic events after use of a PED was 62.7% (37 patients) and neurological symptoms occurred in 8.1% of affected patients. Development of ischemic events was significantly associated with older patients (≥60years; p=0.038). Routine use of platelet function assays and newer P2Y12 receptor inhibitors (ticagrelor) were not associated with fewer thromboembolic events. Conclusions Thromboembolic events are relatively common after treatment with a PED with an incidence comparable to stent-assisted and conventional coiling but the risk of neurological morbidity from ischemic burden is low. Older patients are at particularly increased risk of thromboembolic events.

Original languageEnglish (US)
Pages (from-to)1136-1139
Number of pages4
JournalJournal of NeuroInterventional Surgery
Volume8
Issue number11
DOIs
StatePublished - Nov 1 2016

Keywords

  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Brasiliense, L. B. C., Stanley, M. A., Grewal, S. S., Cloft, H. J., Sauvageau, E., Lanzino, G., Miller, D., Kallmes, D. F., & Hanel, R. (2016). Silent ischemic events after Pipeline embolization device: A prospective evaluation with MR diffusion-weighted imaging. Journal of NeuroInterventional Surgery, 8(11), 1136-1139. https://doi.org/10.1136/neurintsurg-2015-012091