Alexandra R. Paul

Immediate procedural outcomes in 35 consecutive pipeline embolization cases: a single-center, single-user experience

Background and objective Flow diverters are an exciting new class of endovascular devices that treat aneurysms by curative reconstruction of the parent artery. The Pipeline embolization device (PED) is the first FDA-approved intracranial flow diverting device available in the USA. This paper presents periprocedural results with the device in a series of 35 consecutive cases. Methods All patients who underwent PED treatment of an intracranial aneurysm at our institution following FDA approval of the device in April 2011 were included in the series. Patient demographics, aneurysm characteristics, procedural details and technical and clinical outcomes were analyzed. Results Thirty-four patients (age range 23–78 years, mean 56.4 years) with 41 unruptured aneurysms (37 anterior circulation, four posterior circulation, mean size 11.4 mm, 20/21 large or giant) were treated with the PED in 35 cases (one patient had bilateral aneurysms treated on 2 separate occasions). Thirty-four of 35 cases (97%) were successfully completed. A total of 64 PEDs were implanted, with a mean number of 1.2 PEDs implanted per anterior circulation cases and 6.5 per posterior circulation cases. A single PED was implanted in 73% of cases. Immediate flow disruption occurred in 97% of the cases. The overall rate of major stroke or mortality was 3% (1/35 patients). Minor stroke, cranial nerve palsy, transient neurological deficit and groin complication occurred in one patient each (3% each, 12% total). Conclusion Treatment of cerebral aneurysms with the PED carries an acceptable risk profile when a rigorous and uniform technique is used. Although the long-term results will need to be analyzed, the immediate procedural outcomes in the study series using this technique appear quite promising.

Cost comparison of endovascular treatment of anterior circulation aneurysms with the pipeline embolization device and stent-assisted coiling.

BACKGROUND The Pipeline embolization device (PED) is a new endovascular option for wide-necked or fusiform anterior circulation aneurysms that were classically treated by coil embolization with adjunctive use of a stent. However, stent-coiling incurs significant equipment and implant costs. OBJECTIVE To determine whether PED embolization is more economical than stent-assisted coiling. METHODS Sixty consecutive patients with anterior circulation aneurysms who underwent treatment with the PED (30 patients) or by single-stage stent-assisted coiling (30 patients) were identified from a prospective single-center aneurysm database. The hospital costs of equipment and implants were analyzed and compared for each group. RESULTS The mean aneurysm size for patients treated with the PED was 9.8 vs 7.3 mm for patients treated by stent-assisted coiling. The total combined costs of proximal access/guide catheters, microcatheters, and microwires were equivalent between the 2 groups. The cost of implants, however, was significantly lower in the PED group (

In situ removal of the pipeline embolization device: the ‘corking’ and ‘pseudo-corking’ techniques

13175 ± 726 vs

Selection of treatment modalities or observation of dural arteriovenous fistulas.

19069 ± 2015; P = .013), despite this group having a larger mean aneurysm size. Furthermore, the total procedure cost was significantly lower for the PED group vs the stent-coiling group (

Comparison of tertiary-center aneurysm location frequencies in 400 consecutive cases: Decreasing incidence of posterior communicating artery region aneurysms.

16445 ± 735 vs

Establishing Minimal Clinically Important Difference of Spinal Cord Stimulation Therapy in Post-Laminectomy Syndrome

22145 ± 2022; P = .02), a 25.7% cost reduction. This represents a 27.1% reduction in the cost per millimeter of aneurysm treated in the PED group (

P-013 Use of the Solitaire Device for Emergency Revascularization of the Superior Mesenteric Artery

2261 ± 299) vs the stent-coiling group (

Transient Episode of Alice in Wonderland Syndrome after Ventriculoatrial Shunt Revision

3102 ± 193; P = .02). CONCLUSION Treatment of anterior circulation aneurysms by flow diversion with the PED has lower procedure costs compared with treatment with traditional stent-assisted coiling.

Wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques: a multicentre, core lab adjudicated study evaluating safety and durability of occlusion (BRANCH)

The pipeline embolization device (PED) is a revolutionary tool for the endovascular treatment of intracranial aneurysms by flow diversion. Treatment using the PED often requires considerable manipulation and customization by the neurointerventionalist at the time of deployment. Proper use of the PED involves a novel set of techniques and associated jargon, which must be learned by all neurointerventionalists, fellows and residents for safe treatment of patients with this device. In this report, the PED removal techniques referred to as ‘corking’ and ’pseudo-corking’ are described. Corking is used for the removal of a partially deployed in situ PED when the pusher wire is intact whereas ‘pseudo-corking’ is used if the pusher wire is fractured or disconnected. Knowledge of both techniques is necessary for withdrawing the PED in situations of malposition or failed expansion.

P-019 The Plavix Conundrum: Determining Who Will Respond to Plavix

Cranial dural arteriovenous fistulas (DAVFs) represent an important class of cranial vascular lesions. The clinical significance of these lesions is highly dependent on the pattern of venous drainage, with cortical venous reflux being an important marker of an aggressive, high-risk fistula. For asymptomatic benign fistulas, conservative management, consisting of observation with follow-up, is a reasonable option. For symptomatic benign fistulas or aggressive fistulas, treatment is recommended. A variety of treatment modalities are available for DAVF management, including endovascular techniques, open surgery, and radiosurgery. A multimodality approach is often warranted and can offer improved chances of achieving a cure.