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Multicenter Study
. 2023 Apr 1;24(4):e255-e263.
doi: 10.1227/ons.0000000000000552. Epub 2023 Jan 16.

Technical Nuances and Outcomes of Telescoping Pipeline Flow Diverters: A Multicenter Study

Cordell M Baker  1 , Joshua C Hunsaker  2 , Zach A Folzenlogen  3 , Glenn L Pride  4 , David E Case  3 , Babu G Welch  4 , Jonathan A White  4 , Christopher D Roark  3 , Andrew C White  3   4 , Joshua Seinfeld  3 , John Muse  5 , Ramesh Grandhi  1 , Philipp Taussky  1
Affiliations
Multicenter Study

Technical Nuances and Outcomes of Telescoping Pipeline Flow Diverters: A Multicenter Study

Cordell M Baker et al. Oper Neurosurg. .

Abstract

Background: "Telescoping" multiple overlapping Pipeline Embolization Devices (PEDs; Medtronic) has increased their utility by allowing for more impermeable coverage and providing the ability to off-set landing zone sites and extend treatment constructs.

Objective: To consider the technical nuances and challenges of telescoping PEDs for the treatment of intracranial aneurysms.

Methods: Databases from 3 U.S. academic neurovascular centers were retrospectively queried to identify patients with intracranial aneurysms treated with multiple PED constructs. Data on patient and aneurysm characteristics, as well as outcomes including Raymond-Roy occlusion classification, modified Rankin Scale score, and complications, were gathered.

Results: Forty-six patients had 48 intracranial aneurysms treated, including 16 (33%) in whom placement of telescoping PEDs was planned. Fourteen (30%) patients presented with a ruptured aneurysm. Twenty-one aneurysms (44%) were treated with proximal extension, 13 (27%) with distal extension, and 14 (29%) with PED placement inside one another. Thirty (70%) patients had complete aneurysm occlusion at follow-up. Two (4%) patients had to be retreated. Three patients with unruptured and 1 with ruptured aneurysm had a permanent intraprocedural complication. We present descriptive cases illustrating PEDs that were placed inside one another, proximally, distally, and to improve wall apposition because of vessel tortuosity.

Conclusion: Our data indicate a higher than expected complication rate that is likely because of the technical complexity of these cases. The case illustrations presented demonstrate the indications and challenging aspects of telescoping PEDs.

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