title: Pipeline Embolization Device in the Treatment of Recurrent Previously Stented Cerebral Aneurysms.
abstract: The use of the Pipeline Embolization Device in the management of recurrent previously stented cerebral aneurysms is controversial. The aim of this study was to evaluate the efficacy and safety of the Pipeline Embolization Device in the treatment of recurrent, previously stented aneurysms.
  
  
  
  Twenty-one patients with previously stented recurrent aneurysms who later underwent Pipeline Embolization Device placement (group 1) were retrospectively identified and compared with 63 patients who had treatment with the Pipeline Embolization Device with no prior stent placement (group 2). Occlusion at the latest follow-up angiogram, recurrence and retreatment rates, clinical outcome, complications, and morbidity and mortality observed after treatment with the Pipeline Embolization Device were analyzed.
  
  
  
  Patient characteristics were similar between the 2 groups. The mean time from stent placement to recurrence was 25 months. Pipeline Embolization Device treatment resulted in complete aneurysm occlusion in 55.6% of patients in group 1 versus 80.4% of patients in group 2 (P = .036). The retreatment rate in group 1 was 11.1% versus 7.1% in group 2 (P = .62). The rate of good clinical outcome at the latest follow-up in group 1 was 81% versus 93.2% in group 2 (P = .1). Complications were observed in 14.3% of patients in group 1 and 9.5% of patients in group 2 (P = .684).
  
  
  
  The use of the Pipeline Embolization Device in the management of previously stented aneurysms is less effective than the use of this device in nonstented aneurysms. Prior stent placement can worsen the safety and efficacy profile of this device.
authors.affiliation: From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: B
authors.identifier: 0000-0001-6712-2641
authors.initials: B
authors.lastname: Daou
authors.affiliation: Department of Neurological Surgery (R.M.S.), University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: R M
authors.identifier: 0000-0002-7608-0460
authors.initials: RM
authors.lastname: Starke
authors.affiliation: From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: N
authors.identifier: 0000-0002-2422-4346
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: S
authors.identifier: 0000-0002-1054-9414
authors.initials: S
authors.lastname: Tjoumakaris
authors.affiliation: Department of Neurosurgery (D.H.), University of Iowa, Iowa City, Iowa.
authors.forename: D
authors.identifier: 0000-0002-8335-5442
authors.initials: D
authors.lastname: Hasan
authors.affiliation: From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: J
authors.identifier: 0000-0001-5334-2942
authors.initials: J
authors.lastname: Khoury
authors.affiliation: From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
authors.forename: R H
authors.identifier: 0000-0003-1875-9923
authors.initials: RH
authors.lastname: Rosenwasser
authors.affiliation: From the Department of Neurosurgery (B.D., N.C., S.T., J.K., R.H.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania pascal.jabbour@jefferson.edu.
authors.forename: P
authors.identifier: 0000-0002-8965-2413
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome