Treatment of Wide-Necked, Small Aneurysms With Pipeline Stent Results in High Occlusion Rates

By Alex Morrisson

HOUSTON, Tex -- February 28, 2017 -- A new stent device makes it possible to protect patients found to have small to medium-sized wide-mouth brain aneurysms that have not ruptured, researchers reported here at the 2017 International Stroke Conference (ISC).

After 1 year, complete occlusion of the aneurysm without significant restenosis or retreatment was achieved in 83.5% of 138 patients who were implanted with the Pipeline stent device, reported Ricado Hanel, MD, Baptist Neurological Institute, Baptist Health System, Jacksonville, Florida.

The device creates a stented flow diversion that seals off the ballooning blood vessel until it occludes.

In his late-breaker oral presentation on February 22, Dr. Hanel said that 11 patients had a residual aneurysm, 8 had residual neck, 2 developed stenosis of >50%, and 3 patients required retreatment. One patient in the study suffered a fatal stroke in the periprocedural period, another patient experienced a major stroke within 30 days of the treatment, and a third patient experienced a major stroke after stopping dual anti-platelet therapy 169 days after the treatment.

The device is indicated for use in the United States for large aneurysms, but the current study focused on treatment of unruptured, small aneurysms located in the internal carotid artery or the vertebral artery, including the posterior inferior cerebellar artery.

“The treatment of unruptured wide-necked, small/medium aneurysms located in the internal carotid artery with Pipeline results in high occlusion rates at 1 year,” reported Dr. Hanel, adding that the raw of morbidity and mortality was low and that there was no aneurysm recurrence or rupture at 1 year.

The 2.1% rate of complications is acceptable when considering that patients with these small to medium aneurysms have a 0.5% per year risk of having those aneurysms rupture, according to Dr. Hanel.

The mean age of the patients in the study was 54.6 years and about 80% of the patients were women. Most of the patients were diagnosed because of symptoms such as headaches.

Funding for this study was provided by Medtronic.

[Presentation title: Prospective, Multi-Center Study of Flow Diversion for Small and Medium-Sized Aneurysms: Results of the Premier Trial. Abstract LB3]
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