Tiny Pipes: 67 Cases of Flow Diversion for Aneurysms in Distal Vessels Measuring Less Than 2.0 mm

Matthew T. Bender, David A. Zarrin, Jessica K. Campos, Li Mei Lin, Judy Huang, Justin Caplan, Rafael J Tamargo, Geoffrey P. Colby, Alexander Coon

Research output: Contribution to journalArticle

Abstract

Background: Flow diversion is increasingly used for off-label treatments of distal circulation aneurysms. Reports of use in sub-2.0-mm vessels are scant. Methods: A prospectively collected, institutional review board–approved cerebral aneurysm database was reviewed to identify patients who underwent flow diversion with a 2.5-mm diameter Pipeline embolization device. Results: Sixty-seven aneurysms were treated in 67 procedures (66 [99%] successful, 64 [96%] single device, 2 [3%] with 2 devices) in 57 patients. Average age was 56 years and 60% were female. Aneurysm location was 51 (76%) anterior cerebral artery, 14 (21%) middle cerebral artery, and 2 (3%) posterior cerebral artery. Aneurysm size was 4.1 ± 3.0 mm (1–20 mm). Safety outcomes included 3 major strokes (4.5%) resulting in permanent neurologic deficit (modified Rankin Scale score 6,4,4), including 1 mortality (1.5%). Acute stent thrombosis was observed intraprocedurally or within 24 hours of each stroke. There were 2 small-volume (<10 cm 3 , 40 cm 3 ) dependent intracerebral hemorrhage (3.0%) that resolved without permanent neurologic deficit. For effectiveness, 71% of patients underwent follow-up angiography. Complete occlusion was achieved by 88% at 6 months, 86% at 12 months, and 89% at last follow-up. A slight vessel diameter reduction was apparent on average 6.9 months after the procedure, which was statistically significant at the proximal (P = 0.001) but not distal (P = 0.317) device end. Preoperative average parent vessel diameter was 1.9 mm proximally (range, 1.1–2.6 mm) and 1.7 mm distally (range, 1.0–2.3 mm) of the Pipeline embolization device. Follow-up average vessel diameter was 1.7 mm proximally (range, 0.7–2.4 mm) and 1.6 mm distally (range, 0.6–2.1 mm). Flow delay associated with vessel diameter reduction occurred once. There were no cases of asymptomatic vessel occlusion. Conclusions: Flow diversion can be safe and effective for aneurysms originating from vessels <2.0 mm in diameter. Heightened vigilance for the prevention and management of acute stent and vessel thrombosis is warranted in these cases.

Original languageEnglish (US)
JournalWorld neurosurgery
DOIs
StatePublished - Jan 1 2019

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Aneurysm
Equipment and Supplies
Neurologic Manifestations
Stents
Thrombosis
Stroke
Posterior Cerebral Artery
Anterior Cerebral Artery
Cerebral Hemorrhage
Middle Cerebral Artery
Intracranial Aneurysm
Angiography
Databases
Safety
Mortality
Therapeutics

Keywords

  • Distal circulation aneurysms
  • Flow diversion
  • Pipeline embolization device
  • Sub-2.0 mm vessels

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Tiny Pipes : 67 Cases of Flow Diversion for Aneurysms in Distal Vessels Measuring Less Than 2.0 mm. / Bender, Matthew T.; Zarrin, David A.; Campos, Jessica K.; Lin, Li Mei; Huang, Judy; Caplan, Justin; Tamargo, Rafael J; Colby, Geoffrey P.; Coon, Alexander.

In: World neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

Bender, Matthew T. ; Zarrin, David A. ; Campos, Jessica K. ; Lin, Li Mei ; Huang, Judy ; Caplan, Justin ; Tamargo, Rafael J ; Colby, Geoffrey P. ; Coon, Alexander. / Tiny Pipes : 67 Cases of Flow Diversion for Aneurysms in Distal Vessels Measuring Less Than 2.0 mm. In: World neurosurgery. 2019.
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title = "Tiny Pipes: 67 Cases of Flow Diversion for Aneurysms in Distal Vessels Measuring Less Than 2.0 mm",
abstract = "Background: Flow diversion is increasingly used for off-label treatments of distal circulation aneurysms. Reports of use in sub-2.0-mm vessels are scant. Methods: A prospectively collected, institutional review board–approved cerebral aneurysm database was reviewed to identify patients who underwent flow diversion with a 2.5-mm diameter Pipeline embolization device. Results: Sixty-seven aneurysms were treated in 67 procedures (66 [99{\%}] successful, 64 [96{\%}] single device, 2 [3{\%}] with 2 devices) in 57 patients. Average age was 56 years and 60{\%} were female. Aneurysm location was 51 (76{\%}) anterior cerebral artery, 14 (21{\%}) middle cerebral artery, and 2 (3{\%}) posterior cerebral artery. Aneurysm size was 4.1 ± 3.0 mm (1–20 mm). Safety outcomes included 3 major strokes (4.5{\%}) resulting in permanent neurologic deficit (modified Rankin Scale score 6,4,4), including 1 mortality (1.5{\%}). Acute stent thrombosis was observed intraprocedurally or within 24 hours of each stroke. There were 2 small-volume (<10 cm 3 , 40 cm 3 ) dependent intracerebral hemorrhage (3.0{\%}) that resolved without permanent neurologic deficit. For effectiveness, 71{\%} of patients underwent follow-up angiography. Complete occlusion was achieved by 88{\%} at 6 months, 86{\%} at 12 months, and 89{\%} at last follow-up. A slight vessel diameter reduction was apparent on average 6.9 months after the procedure, which was statistically significant at the proximal (P = 0.001) but not distal (P = 0.317) device end. Preoperative average parent vessel diameter was 1.9 mm proximally (range, 1.1–2.6 mm) and 1.7 mm distally (range, 1.0–2.3 mm) of the Pipeline embolization device. Follow-up average vessel diameter was 1.7 mm proximally (range, 0.7–2.4 mm) and 1.6 mm distally (range, 0.6–2.1 mm). Flow delay associated with vessel diameter reduction occurred once. There were no cases of asymptomatic vessel occlusion. Conclusions: Flow diversion can be safe and effective for aneurysms originating from vessels <2.0 mm in diameter. Heightened vigilance for the prevention and management of acute stent and vessel thrombosis is warranted in these cases.",
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AU - Bender, Matthew T.

AU - Zarrin, David A.

AU - Campos, Jessica K.

AU - Lin, Li Mei

AU - Huang, Judy

AU - Caplan, Justin

AU - Tamargo, Rafael J

AU - Colby, Geoffrey P.

AU - Coon, Alexander

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Flow diversion is increasingly used for off-label treatments of distal circulation aneurysms. Reports of use in sub-2.0-mm vessels are scant. Methods: A prospectively collected, institutional review board–approved cerebral aneurysm database was reviewed to identify patients who underwent flow diversion with a 2.5-mm diameter Pipeline embolization device. Results: Sixty-seven aneurysms were treated in 67 procedures (66 [99%] successful, 64 [96%] single device, 2 [3%] with 2 devices) in 57 patients. Average age was 56 years and 60% were female. Aneurysm location was 51 (76%) anterior cerebral artery, 14 (21%) middle cerebral artery, and 2 (3%) posterior cerebral artery. Aneurysm size was 4.1 ± 3.0 mm (1–20 mm). Safety outcomes included 3 major strokes (4.5%) resulting in permanent neurologic deficit (modified Rankin Scale score 6,4,4), including 1 mortality (1.5%). Acute stent thrombosis was observed intraprocedurally or within 24 hours of each stroke. There were 2 small-volume (<10 cm 3 , 40 cm 3 ) dependent intracerebral hemorrhage (3.0%) that resolved without permanent neurologic deficit. For effectiveness, 71% of patients underwent follow-up angiography. Complete occlusion was achieved by 88% at 6 months, 86% at 12 months, and 89% at last follow-up. A slight vessel diameter reduction was apparent on average 6.9 months after the procedure, which was statistically significant at the proximal (P = 0.001) but not distal (P = 0.317) device end. Preoperative average parent vessel diameter was 1.9 mm proximally (range, 1.1–2.6 mm) and 1.7 mm distally (range, 1.0–2.3 mm) of the Pipeline embolization device. Follow-up average vessel diameter was 1.7 mm proximally (range, 0.7–2.4 mm) and 1.6 mm distally (range, 0.6–2.1 mm). Flow delay associated with vessel diameter reduction occurred once. There were no cases of asymptomatic vessel occlusion. Conclusions: Flow diversion can be safe and effective for aneurysms originating from vessels <2.0 mm in diameter. Heightened vigilance for the prevention and management of acute stent and vessel thrombosis is warranted in these cases.

AB - Background: Flow diversion is increasingly used for off-label treatments of distal circulation aneurysms. Reports of use in sub-2.0-mm vessels are scant. Methods: A prospectively collected, institutional review board–approved cerebral aneurysm database was reviewed to identify patients who underwent flow diversion with a 2.5-mm diameter Pipeline embolization device. Results: Sixty-seven aneurysms were treated in 67 procedures (66 [99%] successful, 64 [96%] single device, 2 [3%] with 2 devices) in 57 patients. Average age was 56 years and 60% were female. Aneurysm location was 51 (76%) anterior cerebral artery, 14 (21%) middle cerebral artery, and 2 (3%) posterior cerebral artery. Aneurysm size was 4.1 ± 3.0 mm (1–20 mm). Safety outcomes included 3 major strokes (4.5%) resulting in permanent neurologic deficit (modified Rankin Scale score 6,4,4), including 1 mortality (1.5%). Acute stent thrombosis was observed intraprocedurally or within 24 hours of each stroke. There were 2 small-volume (<10 cm 3 , 40 cm 3 ) dependent intracerebral hemorrhage (3.0%) that resolved without permanent neurologic deficit. For effectiveness, 71% of patients underwent follow-up angiography. Complete occlusion was achieved by 88% at 6 months, 86% at 12 months, and 89% at last follow-up. A slight vessel diameter reduction was apparent on average 6.9 months after the procedure, which was statistically significant at the proximal (P = 0.001) but not distal (P = 0.317) device end. Preoperative average parent vessel diameter was 1.9 mm proximally (range, 1.1–2.6 mm) and 1.7 mm distally (range, 1.0–2.3 mm) of the Pipeline embolization device. Follow-up average vessel diameter was 1.7 mm proximally (range, 0.7–2.4 mm) and 1.6 mm distally (range, 0.6–2.1 mm). Flow delay associated with vessel diameter reduction occurred once. There were no cases of asymptomatic vessel occlusion. Conclusions: Flow diversion can be safe and effective for aneurysms originating from vessels <2.0 mm in diameter. Heightened vigilance for the prevention and management of acute stent and vessel thrombosis is warranted in these cases.

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KW - Flow diversion

KW - Pipeline embolization device

KW - Sub-2.0 mm vessels

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