Pipeline embolization device induced collateral channels in elective flow diversion treatment
Yingming Amy Chen1, Brian J Drake2, Albert Ho Yuen Chiu2
1Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada.
Journal of Neurointerventional Surgery
|March 11, 2016
Summary
The Pipeline Embolization Device (PED) can lead to unexpected collateral vessel formation around treated intracranial aneurysms. These new vessels can perfuse previously thrombosed remnants, highlighting the dynamic nature of aneurysm remodeling.
Area of Science:
- Neuroendovascular therapy
- Cerebrovascular diseases
- Medical device innovation
Background:
- The Pipeline Embolization Device (PED) is a standard treatment for intracranial aneurysms.
- Uncertainty exists regarding PED's impact on cerebral blood flow alterations.
- Persistent perfusion and non-regression of aneurysmal masses are noted issues.
Purpose of the Study:
- To investigate the effects of PED on cerebral blood flow.
- To analyze the development of collateral channels after PED treatment.
- To understand the biological activity of "thrombosed" aneurysmal remnants.
Main Methods:
- Case report of a 68-year-old woman with a giant fusiform paraophthalmic aneurysm treated with PED.
- Antiplatelet therapy was reduced to encourage thrombosis.
- Angiography, cone beam CT angiography, and MRI were used for assessment.
Main Results:
- PED occlusion occurred, but a peri-construct collateral channel formed.
- This collateral channel perfused the aneurysmal remnant and supplied distal branches.
- Imaging confirmed "thrombosed" remnants were biologically active and perfused.
Conclusions:
- PED treatment can induce collateral formation around intracranial aneurysms.
- Apparently thrombosed aneurysmal remnants can remain biologically active and perfused.
- Aneurysmal remodeling is influenced by hemodynamic factors and flow demand.
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