Faculty Collaboration Database

Safety and efficacy of the Pipeline Flex embolization device with Shield Technology for the acute treatment of ruptured internal carotid artery pseudoaneurysms: a multi-institution case series. Neurosurg Focus 2023 May;54(5):E4

Date

05/02/2023

Pubmed ID

37127036

DOI

10.3171/2023.2.FOCUS233

Scopus ID

2-s2.0-85158026844 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

OBJECTIVE: Ruptured blister, dissecting, and iatrogenic pseudoaneurysms are rare pathologies that pose significant challenges from a treatment standpoint. Endovascular treatment via flow diversion represents an increasingly popular option; however, drawbacks include the requirement for dual antiplatelet therapy and the potential for thromboembolic complications, particularly acute complications in the ruptured setting. The Pipeline Flex embolization device with Shield Technology (PED-Shield) offers reduced material thrombogenicity, which may aid in the treatment of ruptured internal carotid artery pseudoaneurysms.

METHODS: The authors conducted a multi-institution, retrospective case series to determine the safety and efficacy of PED-Shield for the treatment of ruptured blister, dissecting, and iatrogenic pseudoaneurysms of the internal carotid artery. Clinical, radiographic, treatment, and outcomes data were collected.

RESULTS: Thirty-three patients were included in the final analysis. Seventeen underwent placement of a single device, and 16 underwent placement of two devices. No thromboembolic complications occurred. Four patients were maintained on aspirin alone, and all others were treated with long-term dual antiplatelet therapy. Among patients with 3-month follow-up, 93.8% had a modified Rankin Scale score of 0-2. Complete occlusion at follow-up was observed in 82.6% of patients.

CONCLUSIONS: PED-Shield represents a new option for the treatment of ruptured blister, dissecting, and iatrogenic pseudoaneurysms of the internal carotid artery. The reduced material thrombogenicity appeared to improve the safety of the PED-Shield device, as this series demonstrated no thromboembolic complications even among patients treated with only single antiplatelet therapy. The efficacy of PED-Shield reported in this series, particularly with placement of two devices, demonstrates its potential as a first-line treatment option for these pathologies.

Author List

Bounajem MT, Joyce E, Scoville JP, Seinfeld J, Hoffman J, Grossberg JA, Waiters V, White AC, Nerva J, Burkhardt JK, Tonetti DA, El Naamani K, Gooch MR, Jabbour P, Tjoumakaris S, Ortega Gutierrez S, Levitt MR, Lang M, Ares WJ, Desai S, Mascitelli JR, Kilburg CJ, Budohoski KP, Couldwell WT, Gross BA, Grandhi R

Author

John D. Nerva MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aneurysm, False
Blister
Carotid Artery, Internal
Cerebral Angiography
Embolization, Therapeutic
Humans
Iatrogenic Disease
Intracranial Aneurysm
Platelet Aggregation Inhibitors
Retrospective Studies
Thromboembolism
Treatment Outcome