Abstract
Flow diversion has become an established treatment option for challenging intracranial aneurysms. The use of small devices of ≤3-mm diameter remains unapproved by major regulatory bodies. A retrospective review of patients treated with Pipeline Embolization Devices of ≤3-mm diameter at 3 Canadian institutions was conducted. Clinical and radiologic follow-up data were collected and reported. Twelve cases were treated with ≥1 Pipeline Embolization Device of ≤3-mm diameter, including 2 with adjunctive coiling, with a median follow-up of 18 months (range, 4-42 months). One patient experienced a posttreatment minor complication (8%) due to an embolic infarct. No posttreatment hemorrhage or delayed complications such as in-stent stenosis/thrombosis were observed. Radiologic occlusion was seen in 9/12 cases (75%) and near-occlusion in 2/12 cases (17%). Intracranial aneurysm treatment with small-diameter flow-diverting stents provided safe and effective aneurysm closure in this small selected sample. These devices should be further studied and considered for regulatory approval.
Highlights
One patient (8%) experienced technical complications with access and required prestenting angioplasty of the parent vessel so that the device could cross the aneurysm
One patient (8%) experienced a clinically significant procedure-related complication, with a distal posterior inferior cerebellar artery (PICA) stroke, which was detected in the immediate postprocedure period with mild dysmetria and limb ataxia, which improved to a minimal deficit during several days
The use of Յ3-mm diameter flow-diversion devices is not currently approved in North America, and there is a paucity of published literature that describes their use
Summary
We conducted a retrospective review at 3 institutions of all endovascular cases using PEDs between June 2008 and July 2013. Patients that were treated with one or more small stents (Յ3.00 mm in diameter) were included in our analysis. The decision to treat was made for each case by a multidisciplinary team, including vascular neurosurgeons and interventional neuroradiologists, and Health Canada approval was individually obtained under an appeal for compassionate use. Pretreatment antiplatelet therapy included both acetylsalicylic acid (325 mg) and a total dose of 600 mg of clopidogrel before the procedure (initiated 5 days prior for unruptured aneurysms or within 24 hours for ruptured aneurysms). In cases in which adjuvant coiling was planned, a 0.014- or 0.018-inch microcatheter was placed into the aneurysm lumen before stent deployment, by using a 5F guide catheter via contralateral femoral access. Discontinuation of clopidogrel was based on imaging findings and the discretion of the treating physician, and the patient was maintained on aspirin only
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