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Edison P. Valle-Giler, Elias Atallah, Stavropoula Tjoumakaris, Robert H. Rosenwasser and Pascal Jabbour

T he Pipeline embolization device (PED) has changed the paradigm of aneurysm treatment since it was approved in 2011. 5 , 13 , 18 The popularity of the PED is based on its efficacy in treating aneurysms when compared with conventional coiling (> 80% vs 66% aneurysm obliteration rate, respectively, with minimal—if any—aneurysm recurrence). 2 , 3 , 5 , 6 , 10 , 13 , 15 Usually the PED deployment is anterograde, with the delivery microcatheter entering the inflow of the aneurysm. Sometimes the deployment can be difficult, mainly because of tortuous anatomy

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Stephen J. Monteith, Asterios Tsimpas, Aaron S. Dumont, Stavropoula Tjoumakaris, L. Fernando Gonzalez, Robert H. Rosenwasser and Pascal Jabbour

-necked aneurysms was positive. 12 , 13 The current literature on the use of flow diversion for the treatment of fusiform aneurysms is limited to small case series or subgroup analysis from large series. We set out to detail our experience at a single center using the Pipeline Embolization Device (PED; Covidien/ev3) for the treatment of fusiform aneurysms in a high-volume center. Methods A retrospective review of 146 patients treated at our institution with the PED (Covidien/ev3) between June 2011 and January 2013 was performed. Angiograms and procedure notes of the 146

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Purvee D. Patel, Nohra Chalouhi, Elias Atallah, Stavropoula Tjoumakaris, David Hasan, Hekmat Zarzour, Robert Rosenwasser and Pascal Jabbour

I n recent years, the Pipeline embolization device (PED) has gained popularity as a treatment option for intracranial aneurysms. This flow diverter is an endoluminal, self-expanding, braided mesh tube made with 48 strands of platinum-tungsten and cobalt-chromium-nickel alloy wires. 5 , 54 It works by diverting blood flow away from the aneurysm, leading to thrombosis of the aneurysm while also maintaining patency of the parent vessel. 54 The device has proven to be a safe and effective therapy for large, giant, and complex intracranial aneurysms. 38 In a

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Badih Daou, Elias Atallah, Nohra Chalouhi, Robert M. Starke, Jeffrey Oliver, Maria Montano, Pascal Jabbour, Robert H. Rosenwasser and Stavropoula I. Tjoumakaris

F low diverters (FDs) are being used with increasing frequency, especially to target large and complex aneurysms that are not amenable to treatment with conventional endovascular methods. 6 , 8 , 9 , 28 The Pipeline embolization device (PED) is the first FD approved by the FDA following the results of the PUFS (Pipeline for Uncoilable or Failed Aneurysms) trial for the management of large or giant wide-necked intracranial aneurysms in the internal carotid artery (ICA) from the petrous to the superior hypophyseal segments. Although initially indicated for a

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Badih Daou, Elias Atallah, Nohra Chalouhi, Robert M. Starke, Jeffrey Oliver, Maria Montano, Pascal Jabbour, Robert H. Rosenwasser and Stavropoula I. Tjoumakaris

F low diverters (FDs) are being used with increasing frequency, especially to target large and complex aneurysms that are not amenable to treatment with conventional endovascular methods. 6 , 8 , 9 , 28 The Pipeline embolization device (PED) is the first FD approved by the FDA following the results of the PUFS (Pipeline for Uncoilable or Failed Aneurysms) trial for the management of large or giant wide-necked intracranial aneurysms in the internal carotid artery (ICA) from the petrous to the superior hypophyseal segments. Although initially indicated for a

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Badih Daou, Edison P. Valle-Giler, Nohra Chalouhi, Robert M. Starke, Stavropoula Tjoumakaris, David Hasan, Robert H. Rosenwasser, Ryan Hebert and Pascal Jabbour

W ith the advancements in endovascular techniques, an increasing number of cerebral aneurysms are being managed using this approach. Flow diversion using the Pipeline Embolization Device (PED) has become a popular method for the management of cerebral aneurysms. In 2011, the PED (Covidien) was approved by the US FDA for the treatment of large and giant wide-neck aneurysms in the internal carotid artery (ICA), from the petrous to the superior hypophyseal segments. Since then, several reports have highlighted the safety and efficacy of the PED in the

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Kate A. Hentschel, Badih Daou, Nohra Chalouhi, Robert M. Starke, Shannon Clark, Ashish Gandhe, Pascal Jabbour, Robert Rosenwasser and Stavropoula Tjoumakaris

D espite recent cerebrovascular advances, ischemic stroke remains a leading cause of morbidity and mortality. The goal of acute ischemic stroke (AIS) interventions is to obtain arterial recanalization and cerebral reperfusion. Over the past decade, 4 mechanical thrombectomy devices have obtained US Food and Drug Administration approval for the treatment of AIS as the sole intervention or as an adjunct to intravenous tissue plasminogen activator (tPA). The MERCI (Mechanical Embolus Removal in Cerebral Ischemia) and Penumbra Pivotal Stroke trials suggested

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Elias Atallah, Hassan Saad, Kimon Bekelis, Nohra Chalouhi, Stavropoula Tjoumakaris, David Hasan, Jorge Eller, David Stidd, Robert H. Rosenwasser and Pascal Jabbour

T he superiority of coil embolization as compared with clip placement in a certain category of brain aneurysms has been demonstrated by the International Subarachnoid Aneurysm Trial. 10 Since its 2011 FDA approval, the Pipeline embolization device (PED; Covidien) has been a favored option in treating cerebral aneurysms. 16 The PED is a self-expanding stent with 30%–35% metal surface area coverage that diverts blood flow from the aneurysm lumen to the downstream arteries, causing aneurysm sac thrombosis. 4 However, there is a window of time until full luminal

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David F. Kallmes, Waleed Brinjikji, Saruhan Cekirge, David Fiorella, Ricardo A. Hanel, Pascal Jabbour, Demetrius Lopes, Pedro Lylyk, Cameron G. McDougall and Adnan Siddiqui

T reatment with the Pipeline embolization device (PED, Covidien/Medtronic) is widely accepted as an excellent option for patients with intracranial aneurysms. 1 , 4 , 5 , 19 Flow diverter devices such as the PED were initially developed for treatment of wide-necked and large and giant aneurysms, aneurysms that are typically difficult to treat with endosaccular coiling, with or without stent assistance. High rates of complete aneurysm occlusion have been reported in a number of studies, even in large and giant aneurysms. 1 , 4 , 5 , 7 , 8 , 17 , 19 To date, a

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Pascal Jabbour, Michael Fehlings, Alexander R. Vaccaro and James S. Harrop

younger patients, the geriatric population often cannot tolerate this technique due to airway and swallowing dysfunction as well as the significant weight of these devices on their frames. An additional difficulty with this fracture in the elderly is the significant incidence of pseudarthrosis, even despite rigid (halo vest) immobilization techniques. Therefore, many surgeons have advocated rigid internal fixation to promote the highest rates of arthrodesis. Nevertheless, the use of a cervical collar is still an option for older patients, as long as the surgeon and