Treatment of Intracranial Aneurysms With Pipeline Embolization Device: Newer Applications and Technical Advances

被引:0
作者
Santosh B. Murthy
Jharna Shah
Halinder S. Mangat
Philip Stieg
机构
[1] Weill Cornell Medical College/New York Presbyterian Hospital,Division of Stroke and Neurocritical Care, Department of Neurology
[2] Weill Cornell Medical College,Feil Family Brain and Mind Research Institute
[3] Johns Hopkins University School of Medicine,Division of Neurosciences Critical Care, Department of Neurology
[4] Weill Cornell Medical College,Department of Neurosurgery
来源
Current Treatment Options in Neurology | 2016年 / 18卷
关键词
Pipeline embolization device; Flow diverter; Intracranial aneurysm; Subarachnoid hemorrhage;
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摘要
Pipeline embolization device (PED) is a flow diverter used in the endovascular treatment of intracranial aneurysms, particularly those with unfavorable configurations. It works by causing progressive flow redirection leading to thrombosis within the aneurysm. PED was initially approved for adults with large or giant wide-necked (≥4 mm or no discernible neck) aneurysms of the internal carotid artery (ICA) from the petrous to the superior hypophyseal segments. Studies have shown a superior aneurysm occlusion rate of 85 % at 6 months for the PED and mortality ranging from 2.6 to 4 %. There appears to be a knowledge gap in terms of the duration of dual antiplatelet therapy and efficacy of assessing platelet inhibition. However, increasing operator experience and favorable longer-term outcome data have led to the exploration of PED for a wide array of off-label uses. Given the paucity of good-quality studies comparing PED with other endovascular/surgical treatment options, several multicenter randomized trials are currently underway to answer these important questions.
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[1]  
Wakhloo AK(1995)Self-expanding nitinol stents in canine vertebral arteries: hemodynamics and tissue response AJNR Am J Neuroradiol 16 1043-51
[2]  
Tio FO(1994)Embolization of experimentally created aneurysms with intravascular stent devices AJNR Am J Neuroradiol 15 1223-31
[3]  
Lieber BB(2010)Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device AJNR Am J Neuroradiol 31 1139-47
[4]  
Schellhammer F(2009)Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience Neurosurgery 64 632-42
[5]  
Graf M(2014)The expanding realm of endovascular neurosurgery: flow diversion for cerebral aneurysm management Methodist DeBakey Cardiovasc J 10 214-9
[6]  
Hopkins LN(2011)Flow diverters for treatment of intracranial aneurysms: current status and ongoing clinical trials J Clin Neurosci 18 737-40
[7]  
Geremia G(2005)Flow changes caused by the sequential placement of stents across the neck of sidewall cerebral aneurysms J Neurosurg 103 891-902
[8]  
Haklin M(2005)Histological postmortem study of an internal carotid artery aneurysm treated with the Neuroform stent Neurosurgery 56 E416-68
[9]  
Brennecke L(2013)Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial Radiology 267 858-40
[10]  
Szikora I(2011)The pipeline embolization device for the intracranial treatment of aneurysms trial AJNR Am J Neuroradiol 32 34-15