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pipeline_embolization_device

Pipeline™ Embolization Device (PED)

The Pipeline embolization device (PED, ev3 Endovascular, Plymouth, MN, USA) and Silk flow-diverting stent (Balt Extrusion, Montmorency, France) is a widely utilized flow diverter in the treatment of intracranial aneurysms, particularly those with unfavorable configurations.


Flow modification has caused a paradigm shift in the management of intracranial aneurysms. Since the FDA approval of the Pipeline Embolization Device (Medtronic, Dublin, Ireland) in 2011, it has grown to become the modality of choice for a range of carefully selected lesions, previously not amenable to conventional endovascular techniques. While the vast majority of flow diverter stents operate from within the parent artery (ie, endoluminal stents), providing a scaffold for endothelial cells growth at the aneurysmal neck while inducing intra-aneurysmal thrombosis, a smaller subset of endosaccular flow disruptors acts from within the lesions themselves 1).


It is a braided, platinum and nickel-cobalt chromium alloy, wire mesh cylindrical implanted device.

An aneurysm treated with a flow diverter is expected to involute over time, contrary to the immediate obliteration expected by surgical clipping or coiling. Yet, which aneurysms will respond to PED therapy and the time frame to expect full obliteration remains unclear 2).

Mechanism

It works by causing progressive flow redirection leading to thrombosis within the aneurysm.

Close to one-fifth of aneurysms, however, fail to occlude after PED placement.

The main mechanism of this stent is to divert the flow in the parent artery with reduction of inflow in the aneurysm leading to thrombosis.

Endothelial cell coverage along the Pipeline embolization device (PED) is one of two primary proposed mechanisms of action of the device, along with induction of intra-aneurysmal thrombosis 3).

Indications

see Pipeline Embolization Device Indications.

see Pipeline embolization device for posterior circulation aneurysm.

Complications

see Pipeline embolization device complications.

Case series

see Pipeline embolization device case series.

Case reports

see Pipeline Embolization Device case reports.

1)
Dmytriw AA, Salem MM, Yang VXD, Krings T, Pereira VM, Moore JM, Thomas AJ. Endosaccular Flow Disruption: A New Frontier in Endovascular Aneurysm Management. Neurosurgery. 2020 Feb 1;86(2):170-181. doi: 10.1093/neuros/nyz017. PubMed PMID: 30834934.
2)
Gressot LV, Patel AJ, Srinivasan VM, Arthur A, Kan P, Duckworth EA. An intraoperative look at failure of flow diversion: when additional or alternative treatments should be considered. World Neurosurg. 2016 Jul 12. pii: S1878-8750(16)30519-8. doi: 10.1016/j.wneu.2016.06.131. [Epub ahead of print] PubMed PMID: 27422683.
3)
Ravindran K, DiStasio M, Laham R, Ogilvy CS, Thomas AJ, VanderLaan PA, Alturki AY. Histopathological demonstration of subacute endothelialization following aneurysm re-treatment with the Pipeline embolization device. World Neurosurg. 2018 Jul 18. pii: S1878-8750(18)31568-7. doi: 10.1016/j.wneu.2018.07.090. [Epub ahead of print] PubMed PMID: 30031197.
pipeline_embolization_device.txt · Last modified: 2020/02/05 20:14 by administrador