title: Concurrent use of the Pipeline Embolization Device and coils for intracranial aneurysms: technique, safety, and efficacy.
abstract: OBJECTIVE
  The use of the Pipeline Embolization Device (PED) as a sole endovascular modality has been described for the treatment of brain aneurysms. The benefit of using coils concurrently with a limited number of PEDs is not well documented. The authors describe their experience with this technique as well as their midterm clinical and angiographic results.
  
  
  METHODS
  This is a retrospective review of patients treated between 2011 and 2014. The authors placed a minimal number of PEDs with the addition of coils using a "jailed" microcatheter technique. A partially dense coil mass was obtained. Immediate and midterm clinical and angiographic results are reviewed.
  
  
  RESULTS
  The authors treated 27 patients harboring 28 aneurysms using this technique. The mean aneurysm size was 11.9 mm, and the mean neck size was 5.4 mm. A mean of 1.48 PEDs were placed per patient, and a mean of 1.33 PEDs per aneurysm were placed. The Raymond score immediately after PED placement was 2 or 3 in 82.1% of the patients. There were no intraprocedural or postprocedural complications. All PEDs were successfully deployed. No clinical or technical adverse effects related to the coil mass were observed. There were no clinical or radiographic signs of ischemia in this group. At follow-up imaging, complete aneurysm occlusion was demonstrated on the first MR angiogram (3-5 months) in all patients who reached this milestone. Follow-up digital subtraction angiography (5-13 months) confirmed complete occlusion in all patients who reached this milestone. All patients maintained their baseline clinical status.
  
  
  CONCLUSIONS
  The deployment of PEDs with concurrent partially dense coiling is safe and efficacious. This technique achieved early complete occlusion and endovascular reconstruction of the parent vessel, without inducing mass effect. Favorable midterm clinical results were observed in all patients.
authors: Departments of 1 Neurosurgery and.
authors: Erez
authors: E
authors: Nossek
authors: David J
authors: DJ
authors: Chalif
authors: Shamik
authors: S
authors: Chakraborty
authors: Kim
authors: K
authors: Lombardo
authors: Karen S
authors: KS
authors: Black
authors: Avi
authors: A
authors: Setton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D057785:Catheters; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: ICA = internal carotid artery; MRA = MR angiography; PED = Pipeline Embolization Device; PRU = P2Y12 reaction units; Pipeline Embolization Device; aneurysm; brain; coil; mRS = modified Rankin Scale; vascular disorders