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Research ArticleNeurointervention

Risk Factors for Hemorrhagic Complications following Pipeline Embolization Device Treatment of Intracranial Aneurysms: Results from the International Retrospective Study of the Pipeline Embolization Device

W. Brinjikji, G. Lanzino, H.J. Cloft, A.H. Siddiqui and D.F. Kallmes
American Journal of Neuroradiology December 2015, 36 (12) 2308-2313; DOI: https://doi.org/10.3174/ajnr.A4443
W. Brinjikji
aFrom the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)
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G. Lanzino
aFrom the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)
bNeurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
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H.J. Cloft
aFrom the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)
bNeurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
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A.H. Siddiqui
cDepartment of Neurosurgery (A.H.S.), State University of New York, Buffalo, New York.
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D.F. Kallmes
aFrom the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)
bNeurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota
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Article Figures & Data

Tables

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    Table 1:

    Demographic and aneurysm characteristics

    CharacteristicsIPH/SubtotalORP Value
    Sex
        Male2.5% (4/161)Ref
        Female2.5% (16/632)1.02 (0.34–3.09).97
    Hypertension
        Yes5.2% (13/249)2.45 (0.96–6.23).06
        No2.2% (7/318)Ref
    Controlled hypertension
        Yes5.8% (12/206)0.58 (0.02–15.92).75
        No0.0% (0/4)Ref
    Current smoker
        Yes3.2% (3/94)1.32 (0.38–4.60).66
        No2.4% (17/699)Ref
    Aneurysm location
        Posterior circulation2.2% (2/89)Ref
        Anterior circulation2.6% (18/704)1.14 (0.26–5.00).86
    Aneurysm location by vessel
        Internal carotid artery2.4% (14/590)Ref
        PcomA3.8% (2/53)1.61 (0.36–7.30).78
        ACA25.0% (2/8)13.71 (2.54–74.02).01
        Basilar artery2.3% (1/43)0.98 (0.13–7.63).43
        Vertebral artery3.0% (1/33)1.29 (0.16–10.09).63
    Rupture status
        Unruptured1.9% (14/719)Ref
        Ruptured8.1% (6/74)4.44 (1.65–11.94).00
    Aneurysm type
        Saccular2.0% (12/600)Ref
        Fusiform3.9% (4/102)1.92 (0.42–8.82).91
        Dissecting3.8% (2/53)2.00 (0.63–6.33).82
        Other5.3% (2/38)2.72 (0.59–12.63).48
    Aneurysm size
        <10 mm1.6% (6/387)Ref
        10–24.9 mm3.3% (11/338)2.14 (0.78–5.84).70
        ≥25 mm4.8% (3/63)3.18 (0.77–13.04).23
    • Note:—PcomA indicates posterior communicating artery; ACA, anterior cerebral artery; Ref, reference.

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    Table 2:

    Procedure and device characteristics

    CharacteristicsIPH/SubtotalaORP Value
    Preprocedural antiplatelet use
        Yes2.5% (17/681)0.93 (0.27–3.23).91
        No2.7% (3/112)Ref
    Preprocedural platelet aggregation studies
        Yes2.5% (14/564)0.95 (0.36–2.49).91
        No2.6% (6/229)Ref
    Heparin administration
        Yes2.6% (18/704)1.14 (0.26–5.00).86
        No2.2% (2/89)Ref
    Reversal of heparin
        Yes5.6% (1/18)2.33 (0.29–18.49).43
        No2.5% (17/689)Ref
    No. of PEDs used
        11.7% (9/533)Ref
        23.3% (6/183)1.97 (0.69–5.62).96
        3+6.6% (5/76)4.10 (1.34–12.58).04
    How multiple PEDs were used
        Overlapping1.4% (2/140)Ref
        Multiple layers7.5% (3/40)5.59 (0.90–34.72).96
        Additional length7.9% (6/76)5.91 (1.16–30.06).96
        Multiple layers and overlapping0.0% (0/2)NA
    Sheaths used
        Medical Arrow-Flexb
            Yes0.0% (0/35)NA
            No3.5% (19/546)
        Medical Shuttle Select
            Yes3.2% (8/249)0.97 (0.38–2.45).95
            No3.3% (11/332)Ref
        Pinnacle Destinationc
            Yes5.9% (2/34)1.95 (0.43–8.80).39
            No3.1% (17/547)Ref
    Microcatheter used
        Marksmand
            Yes3.2% (18/557)0.77 (0.10–6.00).80
            No4.2% (1/24)Ref
    • ↵a The number of IPHs does not add up to 20 in all subanalyses because these data were missing in some patients.

    • ↵b Teleflex, Limerick, Pennsylvania.

    • ↵c Terumo, Tokyo, Japan.

    • ↵d Covidien, Irvine, California.

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American Journal of Neuroradiology: 36 (12)
American Journal of Neuroradiology
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1 Dec 2015
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W. Brinjikji, G. Lanzino, H.J. Cloft, A.H. Siddiqui, D.F. Kallmes
Risk Factors for Hemorrhagic Complications following Pipeline Embolization Device Treatment of Intracranial Aneurysms: Results from the International Retrospective Study of the Pipeline Embolization Device
American Journal of Neuroradiology Dec 2015, 36 (12) 2308-2313; DOI: 10.3174/ajnr.A4443

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Risk Factors for Hemorrhagic Complications following Pipeline Embolization Device Treatment of Intracranial Aneurysms: Results from the International Retrospective Study of the Pipeline Embolization Device
W. Brinjikji, G. Lanzino, H.J. Cloft, A.H. Siddiqui, D.F. Kallmes
American Journal of Neuroradiology Dec 2015, 36 (12) 2308-2313; DOI: 10.3174/ajnr.A4443
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Cited By...

  • Nomogram for predicting delayed intraparenchymal hemorrhage after pipeline embolization device treatment in patients with intracranial aneurysms: a multicenter, retrospective model development and validation study
  • Cost-Effectiveness of Platelet Function Testing in Dual Antiplatelet Therapy Decision-Making after Intracranial Aneurysm Treatment with Flow Diversion
  • Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms - SCENT: 3-year outcomes
  • Excessive platelet inhibition following Pipeline embolization of intracranial aneurysms
  • Using angiographic parametric imaging-derived radiomics features to predict complications and embolization outcomes of intracranial aneurysms treated by pipeline embolization devices
  • Safety and efficacy of ticagrelor as single antiplatelet therapy in prevention of thromboembolic complications associated with the Pipeline Embolization Device (PED): multicenter experience
  • Downstream vascular changes after flow-diverting device deployment in a rabbit model
  • On Flow Diversion: The Changing Landscape of Intracerebral Aneurysm Management
  • Republished: Stent-assisted coil embolization on down-the-barrel view with spring-shaped microcatheter in patient with M1 ultrawide necked circumferential aneurysm
  • Middle cerebral artery flow velocity increases more in patients with delayed intraparenchymal hemorrhage after Pipeline
  • Stent-assisted coil embolization on down-the-barrel view with spring-shaped microcatheter in patient with M1 ultrawide necked circumferential aneurysm
  • Early angiographic signs of acute thrombus formation following cerebral aneurysm treatment with the Pipeline embolization device
  • Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature
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