L-D Jou1, B D Mitchell2, H M Shaltoni3, M E Mawad3. 1. From the Departments of Radiology (L.-D.J., H.M.S., M.E.M.) jou@bcm.tmc.edu. 2. Neurosurgery (B.D.M.), Baylor College of Medicine, Houston, Texas. 3. From the Departments of Radiology (L.-D.J., H.M.S., M.E.M.).
Abstract
BACKGROUND AND PURPOSE: During endovascular treatment of unruptured aneurysms with the Pipeline Embolization Device, an oversized device is often selected to achieve better wall apposition; however, this device oversizing could be related to overelongation and possible delayed enlargement of the stented region. The purpose of this study is to investigate the relationship between oversize and treatment outcome. MATERIALS AND METHODS: The DynaCT images of 14 aneurysms treated by a single Pipeline Embolization Device were retrospectively analyzed. 3D images of the deployed device were compared with those acquired at the 6-month follow-up for qualitative and quantitative evaluation. The diameter and length of the Pipeline Embolization Device were measured at both time points and compared for determination of the device changes. RESULTS: Structural changes of the device have been observed, and it was found that the Pipeline Embolization Device influences the vessel curvature in some cases. On average, it increases its diameter by 0.23 mm and decreases its length by 2.88 mm within 6 months of initial deployment. Excessive elongation beyond its nominal length is correlated with a lower aneurysm occlusion rate at the 6-month follow-up. CONCLUSIONS: Not only does a Pipeline Embolization Device reconstruct the aneurysm and parent artery, but its entire structure goes through a gradual remodeling process. The relative deformation between the device and the artery indicates suboptimal wall apposition. Device oversizing does not have a direct effect on shortening or recoil. The aneurysm occlusion rate, however, is lowered by overelongation of the Pipeline Embolization Device.
BACKGROUND AND PURPOSE: During endovascular treatment of unruptured aneurysms with the Pipeline Embolization Device, an oversized device is often selected to achieve better wall apposition; however, this device oversizing could be related to overelongation and possible delayed enlargement of the stented region. The purpose of this study is to investigate the relationship between oversize and treatment outcome. MATERIALS AND METHODS: The DynaCT images of 14 aneurysms treated by a single Pipeline Embolization Device were retrospectively analyzed. 3D images of the deployed device were compared with those acquired at the 6-month follow-up for qualitative and quantitative evaluation. The diameter and length of the Pipeline Embolization Device were measured at both time points and compared for determination of the device changes. RESULTS: Structural changes of the device have been observed, and it was found that the Pipeline Embolization Device influences the vessel curvature in some cases. On average, it increases its diameter by 0.23 mm and decreases its length by 2.88 mm within 6 months of initial deployment. Excessive elongation beyond its nominal length is correlated with a lower aneurysm occlusion rate at the 6-month follow-up. CONCLUSIONS: Not only does a Pipeline Embolization Device reconstruct the aneurysm and parent artery, but its entire structure goes through a gradual remodeling process. The relative deformation between the device and the artery indicates suboptimal wall apposition. Device oversizing does not have a direct effect on shortening or recoil. The aneurysm occlusion rate, however, is lowered by overelongation of the Pipeline Embolization Device.
Authors: S H Duda; J Wiskirchen; G Tepe; M Bitzer; T W Kaulich; D Stoeckel; C D Claussen Journal: J Vasc Interv Radiol Date: 2000-05 Impact factor: 3.464
Authors: Mircea Ionescu; Ralph W Metcalfe; Dianna Cody; Miguel Valdivia Y Alvarado; John Hipp; Goetz Benndorf Journal: Acad Radiol Date: 2011-07 Impact factor: 3.173
Authors: A Rouchaud; C Ramana; W Brinjikji; Y-H Ding; D Dai; T Gunderson; J Cebral; D F Kallmes; R Kadirvel Journal: AJNR Am J Neuroradiol Date: 2016-07-07 Impact factor: 3.825
Authors: Hannes Luecking; Arnd Doerfler; Philipp Goelitz; Philip Hoelter; Tobias Engelhorn; Stefan Lang Journal: Interv Neuroradiol Date: 2019-10-09 Impact factor: 1.610