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Tourniquet parent artery occlusion after flow diversion.
- Source :
-
Journal of neurointerventional surgery [J Neurointerv Surg] 2018 Feb; Vol. 10 (2), pp. 122-126. Date of Electronic Publication: 2017 Mar 06. - Publication Year :
- 2018
-
Abstract
- Background: The Pipeline Embolization Device (PED) is increasingly used for both on- and off-label purposes for treatment of intracranial aneurysms. The device gradually slows flow of blood into the aneurysm, but the high metal coverage of PED promotes endothelialization of the device. Occasionally, this leads to in-stent stenosis that is clinically well tolerated. We present a multi-institutional Pipeline series that includes three cases of gradual asymptomatic occlusion within the PED and parent vessel.<br />Methods: Institutional databases at each participating center were searched for patients treated with the PED. Patients with at least 50% stenosis or occlusion were selected and all relevant clinical and radiographic data were reviewed.<br />Results: A total of 326 cases performed by five neurointerventionalists across four institutions were reviewed. Among these there were three cases of complete occlusion and two cases of stenosis of more than 50%, for an occlusion rate of 0.9%. All patients were clinically asymptomatic.<br />Conclusions: A gradual tourniquet-like occlusion can occur following placement of the PED, leading to vessel occlusion. This has been clinically well tolerated by patients in our series due to the formation of pial collaterals as the stenosis progresses, likely due to ischemic preconditioning. Small parent vessel, pre-existing stenosis, fusiform pathology, overlapping devices, and suboptimal antiplatelet therapy seem to be predisposing factors. Further experience and follow-up will allow us to characterize the risk factors and optimize post-procedural therapy for these patients.<br />Competing Interests: Competing interests: PK is a consultant for Stryker and Medtronic. PK and VMS receive grant/research support from Microvention. AP has received grant/research support from and serves as a consultant to Codman, Covidien, and Stryker Neurovascular.<br /> (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
- Subjects :
- Adult
Aged
Cerebral Angiography trends
Cerebrovascular Disorders etiology
Embolization, Therapeutic instrumentation
Female
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications diagnostic imaging
Postoperative Complications etiology
Retrospective Studies
Tourniquets
Treatment Outcome
Cerebrovascular Disorders diagnostic imaging
Embolization, Therapeutic adverse effects
Intracranial Aneurysm diagnostic imaging
Intracranial Aneurysm therapy
Stents adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1759-8486
- Volume :
- 10
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of neurointerventional surgery
- Publication Type :
- Academic Journal
- Accession number :
- 28265011
- Full Text :
- https://doi.org/10.1136/neurintsurg-2016-012937