title: Urgent off-label use of the pipeline flow diverter stent in selected ischemic cerebrovascular conditions: thrombotic segments and tortuous arteries.
abstract: OBJECTIVE
  Flow diverter stents were originally designed for the endovascular management of certain types of cerebral aneurysms; however, these devices present characteristics that make them more suitable that regular carotid stents or neurostents for the management of selected ischemic cerebrovascular conditions.
  
  
  METHODS
  Eight patients with steno-occlusive disease of the internal carotid (ICA) or vertebral (VA) arteries underwent endovascular reconstruction by means of flow diverter stent implant at our center. Five patients presented with ICA steno-occlusive lesions that involved tortuous segments not amenable to regular carotid stent placement and three patients presented with severe and complex proximal VA dissections.
  
  
  RESULTS
  In all cases the procedures were considered technically successful. Flow diverter stent implant allowed recanalization of the treated vessels (stenosis of 89±10.5% was improved to 26±13%) without procedure related complications. At the 3 month clinical and radiological follow-up, patients either improved or remained stable, and showed stent patency. One patient presented with asymptomatic occlusion of the revascularized artery at 13 months, emphasizing the need for prolonged antiplatelet therapy.
  
  
  CONCLUSIONS
  This preliminary series of patients with high risk steno-occlusive lesions affecting tortuous arterial segments or presenting with heavy thrombotic load managed by the implant of flow diverter stents shows that this approach is feasible, safe, and effective in achieving arterial recanalization. Further studies will elucidate the role of this technique in ischemic cerebrovascular settings.
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: José E
authors.initials: JE
authors.lastname: Cohen
authors.affiliation: Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: J Moshe
authors.initials: JM
authors.lastname: Gomori
authors.affiliation: Department of Neurosurgery, Sheba Medical Center, Tel Aviv, Israel.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Rajz
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Itshayek
authors.affiliation: Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Roni
authors.initials: R
authors.lastname: Eichel
authors.affiliation: Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ronen R
authors.initials: RR
authors.lastname: Leker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056687:Off-Label Use; D011859:Radiography; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Artery; Dissection; Flow Diverter; Stent; Stroke