Silent ischemic events after Pipeline embolization device: a prospective evaluation with MR diffusion-weighted...

Area of Science:

• Neuroendovascular surgery
• Cerebrovascular disease management

Background:

• Endovascular interventions, particularly with flow diverters like the Pipeline Embolization Device (PED), carry a risk of ischemic events due to complexity and high metal content.
• Thromboembolic complications are a known concern in neuroendovascular procedures.

Purpose of the Study:

• To determine the incidence of thromboembolic lesions following Pipeline Embolization Device (PED) treatment.
• To identify potential risk factors associated with these lesions.

Main Methods:

• Prospective study of 59 patients undergoing elective PED treatment over 12 months.
• Postprocedural diffusion-weighted imaging (DWI) at 24 hours to detect ischemic lesions.
• Correlation of demographic, aneurysm, antiplatelet, and perioperative data with ischemic event rates.

Main Results:

• The incidence of silent ischemic events after PED use was 62.7%, with neurological symptoms in 8.1% of affected patients.
• Older age (≥60 years) was significantly associated with an increased risk of ischemic events (p=0.038).
• Routine platelet function assays and ticagrelor use did not reduce thromboembolic events.

Conclusions:

• Thromboembolic events are frequent after PED treatment, comparable to other techniques like stent-assisted coiling.
• Despite a high incidence of silent ischemic events, the risk of neurological morbidity is low.
• Older patients represent a higher-risk group for thromboembolic events following PED intervention.