Abstract | OBJECTIVE: Flow diversion for posterior circulation aneurysms performed using the Pipeline embolization device (PED) constitutes an increasingly common off-label use for otherwise untreatable aneurysms. The safety and efficacy of this treatment modality has not been assessed in a multicenter study. METHODS: A retrospective review of prospectively maintained databases at 8 academic institutions was performed for the years 2009 to 2016 to identify patients with posterior circulation aneurysms treated with PED placement. RESULTS: A total of 129 consecutive patients underwent 129 procedures to treat 131 aneurysms; 29 dissecting, 53 fusiform, and 49 saccular lesions were included. At a median follow-up of 11 months, complete and near-complete occlusion was recorded in 78.1%. Dissecting aneurysms had the highest occlusion rate and fusiform the lowest. Major complications were most frequent in fusiform aneurysms, whereas minor complications occurred most commonly in saccular aneurysms. In patients with saccular aneurysms, clopidogrel responders had a lower complication rate than did clopidogrel nonresponders. The majority of dissecting aneurysms were treated in the immediate or acute phase following subarachnoid hemorrhage, a circumstance that contributed to the highest mortality rate in those aneurysms. CONCLUSIONS:
|
Authors | Christoph J Griessenauer, Christopher S Ogilvy, Nimer Adeeb, Adam A Dmytriw, Paul M Foreman, Hussain Shallwani, Nicola Limbucci, Salvatore Mangiafico, Ashish Kumar, Caterina Michelozzi, Timo Krings, Vitor Mendes Pereira, Charles C Matouk, Mark R Harrigan, Hakeem J Shakir, Adnan H Siddiqui, Elad I Levy, Leonardo Renieri, Thomas R Marotta, Christophe Cognard, Ajith J Thomas |
Journal | Journal of neurosurgery
(J Neurosurg)
Vol. 130
Issue 3
Pg. 923-935
(05 04 2018)
ISSN: 1933-0693 [Electronic] United States |
PMID | 29726768
(Publication Type: Journal Article, Multicenter Study)
|
Chemical References |
- Platelet Aggregation Inhibitors
- Clopidogrel
|
Topics |
- Adult
- Aged
- Aged, 80 and over
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation
(adverse effects, methods)
- Clopidogrel
(therapeutic use)
- Databases, Factual
- Embolization, Therapeutic
(adverse effects, methods, mortality)
- Female
- Follow-Up Studies
- Humans
- Intracranial Aneurysm
(mortality, therapy)
- Magnetic Resonance Angiography
- Male
- Middle Aged
- Platelet Aggregation Inhibitors
(therapeutic use)
- Postoperative Complications
(diagnostic imaging, epidemiology)
- Retrospective Studies
- Treatment Outcome
|