Dataset Information

Retrograde trans-anterior communicating artery rescue of unopened Pipeline Embolization Device with balloon dilation: complication management.

ABSTRACT: As the use of the Pipeline Embolization Device (PED) for the treatment of complex intracranial aneurysms rises, knowledge about complications continues to accumulate amidt a paucity of reports on techniques and rescue strategies. We describe the case of a 70-year-old woman who presented with worsening reto-orbital left-sided pain and a large cavernous aneurysm. The patient underwent endovascular treatment with PED, and there was difficulty delivering the device due to significant vascular tortuosity. This resulted in poor PED deployment as the proximal end failed to open. Increasingly aggressive strategies were attempted to open the device, which resulted in an iatrogenic carotid cavernous fistula. We were finally able to rescue the device and open its proximal end with balloon inflation after using a contralateral trans-anterior communicating artery approach and crossing the PED in a retrograde fashion. Excessive vascular tortuosity poses a genuine risk of PED malfunction and poor deployment. Although we were able to rescue the device and our patient had no permanent morbidity, difficult vascular anatomy rendered the procedure extremely complicated with dreaded complications.

SUBMITTER: Navarro R

PROVIDER: S-EPMC3912398 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Retrograde trans-anterior communicating artery rescue of unopened Pipeline Embolization Device with balloon dilation: complication management.

Navarro Ramon R Yoon Jang J Dixon Tanya T Miller David A DA Hanel Ricardo A RA Tawk Rabih G RG

BMJ case reports 20140127

As the use of the Pipeline Embolization Device (PED) for the treatment of complex intracranial aneurysms rises, knowledge about complications continues to accumulate amidt a paucity of reports on techniques and rescue strategies. We describe the case of a 70-year-old woman who presented with worsening reto-orbital left-sided pain and a large cavernous aneurysm. The patient underwent endovascular treatment with PED, and there was difficulty delivering the device due to significant vascular tortuo ...[more]

PMID: 24469910

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Project description:During intracranial aneurysm embolization with the Pipeline embolization device (PED), ischemic and hemorrhagic complications have been observed in cases among Western populations. The postmarket multicenter registry study on the embolization of intracranial aneurysms with the PED in China, i.e., the PLUS study, was performed to assess real-world predictors of complications and functional outcomes in patients treated with the PED in a Chinese population. All patients with intracranial aneurysms who underwent embolization using the PED between November 2014 and October 2019 across 14 centers in China were included. The study endpoints included preoperative and early postoperative (< 30 days) functional outcomes (modified Rankin scale [mRS] scores) and complications related to PED treatment at early postoperative and follow-up time points (3-36 months). Multivariate analysis was performed to identify risk factors for complications. A total of 1171 consecutive patients (mean age, 53.9 ± 11.4; female, 69.6% [813/1171]) with 1322 aneurysms were included in the study. Hypertension, basilar artery aneurysms, and successful deployment after adjustment or unsuccessful device deployment were found to be independent predictors of ischemic stroke, while the use of the Flex PED and incomplete occlusion immediately after treatment were protective factors. An aneurysm size > 10 mm, distal anterior circulation aneurysms, and adjunctive coiling were found to be independent predictors of delayed aneurysm rupture, distal intraparenchymal hemorrhage, and neurological compression symptoms, respectively. The rate of PED-related complications in the PLUS study was similar to that in Western populations. The PLUS study identified successful deployment after adjustment or unsuccessful device deployment and the degree of immediate postoperative occlusion as novel independent predictors of PED-related ischemic stroke in a Chinese population. ClinicalTrial.gov Identifier: NCT03831672.

Dataset Information

Retrograde trans-anterior communicating artery rescue of unopened Pipeline Embolization Device with balloon dilation: complication management.

Publications

Retrograde trans-anterior communicating artery rescue of unopened Pipeline Embolization Device with balloon dilation: complication management.

Similar Datasets

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