INTRODUCTION This study assessed the safety and effectiveness of the Pipeline embolization device (PED) for persistent and recurrent aneurysms previously treated with either a vascular reconstruction device (VRD) or a flow diverter (FD). METHODS A prospective, IRB-approved database was analyzed for patients treated with PED for aneurysms previously treated with a stent. RESULTS Twenty procedures were performed on 18 patients, 11 with prior FD, 7 with VRD, and 2 previously treated with both. Overall, 15 aneurysms were saccular (75%), and size was 13.5 ± 7.6 mm. Location was internal carotid artery (ICA) in 14 cases (70%) and posterior circulation in 6 cases (30%). Average prior treatments were 1.7. Previously FD cases were re-treated at an average of 18.1 months from most recent treatment. Each case used 1 device, 82% with distal coverage and 82% with proximal coverage of prior stent. Balloon remodeling was performed in 3 cases (27%) and no in-stent thrombosis was observed. Previously VRD stent-coiled cases were re-treated at an average of 87.5 months. These cases used on average 1.9 devices, 89% with distal and 100% proximal coverage. Adjunctive coiling was performed in 1 case (11%), balloon remodeling in 5 cases (56%), and 2 cases (28%) developed thrombosis that resolved with abciximab. Re-VRD cases were longer (59.1 vs. 33.7 min, p = 0.02) than re-FD. Angiographic follow-up was available for 16 cases (80%). In re-FD, occlusion was complete in 56% and partial progressive in 33% at 17.1 months digital subtraction angiography. In re-VRD, occlusion was complete in 57% and partial progressive in 27% at 8.1 months. Two complications occurred (10%), including one asymptomatic cervical ICA occlusion and one stent occlusion with associated mortality (5%). Clinical follow-up was 17.8 months on average (range 0.5-51.9). CONCLUSIONS Salvage flow diversion for previously stented aneurysms is technically challenging but offers good prospects of aneurysm obliteration with acceptable complication rates.

中文翻译：

---

管道栓塞用于先前支架残留和复发性脑动脉瘤的抢救治疗。

引言 本研究评估了管道栓塞装置 (PED) 对先前使用血管重建装置 (VRD) 或分流器 (FD) 治疗的持续性和复发性动脉瘤的安全性和有效性。方法 前瞻性、IRB 批准的数据库对先前使用支架治疗的动脉瘤患者进行了 PED 治疗。结果 18 名患者进行了 20 次手术，11 名既往 FD，7 名 VRD，2 名既往接受过两种治疗。总体而言，15 个动脉瘤为囊状 (75%)，大小为 13.5 ± 7.6 mm。14例（70%）位于颈内动脉（ICA），6例（30%）位于后循环。平均先前的治疗是1.7。以前的 FD 病例在最近一次治疗后平均 18.1 个月后再次治疗。每个案例使用 1 个设备，82% 有远端覆盖，82% 有先前支架的近端覆盖。3例（27%）进行了球囊重塑，未观察到支架内血栓形成。之前的 VRD 支架盘绕病例平均再治疗 87.5 个月。这些病例平均使用 1.9 个装置，其中 89% 具有远端覆盖率和 100% 近端覆盖率。1 例 (11%) 进行了辅助弹簧圈，5 例 (56%) 进行了球囊重塑，2 例 (28%) 发生血栓形成，阿昔单抗解决。Re-VRD 病例比 re-FD 更长（59.1 对 33.7 分钟，p = 0.02）。16 例 (80%) 可进行血管造影随访。在重新 FD 中，在 17.1 个月的数字减影血管造影中，56% 的阻塞是完全的，33% 的阻塞是部分进展的。在重新 VRD 中，在 8.1 个月时，57% 的阻塞是完全的，27% 的阻塞是部分进展的。发生了两种并发症（10%），包括 1 例无症状的颈段 ICA 闭塞和 1 例相关死亡率的支架闭塞 (5%)。临床随访平均为 17.8 个月（范围 0.5-51.9）。结论 先前支架动脉瘤的抢救性血流分流在技术上具有挑战性，但在并发症发生率可接受的情况下提供了动脉瘤闭塞的良好前景。