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L. Ian Taylor, James C. Dickerson, Robert J. Dambrino, M. Yashar S. Kalani, Philipp Taussky, Chad W. Washington and Min S. Park

S ince the approval of the Pipeline embolization device (PED; Medtronic) by the US Food and Drug Administration in 2011, flow diversion has become a much more common and accepted treatment modality for both the originally intended large and giant cerebral aneurysms of the cavernous and paraclinoid internal carotid arteries and for aneurysms that would fall outside the initially approved indications. Because of the prothrombotic nature of bare metal stents placed within the vasculature, thromboembolic events and in-stent thrombosis are significant risks

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Ramon Navarro, Benjamin L. Brown, Alexandra Beier, Nathan Ranalli, Philipp Aldana and Ricardo A. Hanel

and an obliteration rate of 96% with a mean 3-year follow-up. 13 Flow diversion is a relatively new technique that is increasingly used to treat intracranial aneurysms. In the United States, the most widely used flow diverter is the PED. It is a self-expanding bimetallic stent-like device that has a higher metal surface coverage (approximately 30%–35%) and lower porosity than other stents. The PED helps to divert flow away from the aneurysm, and thus promoting early thrombosis. The dense scaffold then facilitates neointimal growth with parent vessel remodeling. A

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Kathryn Wagner, Aditya Srivatsan, Alina Mohanty, Visish M. Srinivasan, Yasir Saleem, Jacob Cherian, Robert F. James, Stephen Chen, Jan-Karl Burkhardt, Jeremiah Johnson and Peter Kan

T reatment options for unruptured intracranial aneurysms (UIAs) have evolved and improved over the past decades. Flow diversion (FD) is becoming increasingly favored for sidewall intracranial aneurysms. 19–21 Initially approved for proximal large carotid artery aneurysms, the Pipeline embolization device (PED) has expanded indications including for smaller aneurysms up to the carotid terminus. 15 As the safety and efficacy data accumulate, FD is increasingly used to treat intracranial aneurysms of various morphologies and locations. Despite the procedure

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Jean Raymond, Jean-Christophe Gentric, Tim E. Darsaut, Daniela Iancu, Miguel Chagnon, Alain Weill and Daniel Roy

F low diversion is a new endovascular treatment of intracranial aneurysms. 1 , 3 Unlike coil embolization, in which the goal is to occlude the aneurysm sac, treatment with flow diversion attempts to normalize arterial flow and repair the vessel bearing the aneurysm. Flow diverters have been approved for the treatment of large and giant aneurysms of the cavernous to superior hypophyseal segments of the carotid artery, but usage has expanded to other difficult aneurysms, and more recently to small aneurysms treatable by other means. 6 , 13 , 16 , 19 , 21 , 25

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Craig Kilburg, Philipp Taussky, M. Yashar S. Kalani and Min S. Park

the AVM. If indicated, the aneurysm can be treated separately from the AVM or surgically at the time of the AVM treatment. Coil embolization has been the mainstay of endovascular treatment when aneurysm treatment is performed separately from any planned AVM treatment. 2 , 13 , 21 Flow diversion technology has introduced a new technique for the treatment of large and giant cerebral aneurysms of the internal carotid artery (ICA). 3 , 17 Since its introduction, there has been growing enthusiasm for its use in cerebral aneurysms that do not fall within the initial

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Al-Wala Awad, Karam Moon, Nam Yoon, Marcus D. Mazur, M. Yashar S. Kalani, Philipp Taussky, Cameron G. McDougall, Felipe C. Albuquerque and Min S. Park

multiple aneurysms during a single procedure. 25 , 29 Here, we report outcomes in this unique patient subset through a multicenter effort to treat tandem aneurysms in a single treatment session using PEDs. Methods After receiving approval from the institutional review boards at each institution, we performed a retrospective review of flow diversion with the PED to treat tandem aneurysms during a single treatment session. All adults treated in the period from January 2011 through December 2015 at 2 participating centers—University of Utah Hospital in Salt Lake City, Utah

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Spencer Twitchell, Hussam Abou-Al-Shaar, Jared Reese, Michael Karsy, Ilyas M. Eli, Jian Guan, Philipp Taussky and William T. Couldwell

diverter devices for complex aneurysm treatment has affected the cost of care for patients treated for aneurysms. Therefore, the aim of this study was to evaluate specific cost drivers for surgical clipping and endovascular management (i.e., coil embolization and flow diversion) of both ruptured and unruptured intracranial aneurysms using the VDO system. Methods The study was approved by the IRB at the University of Utah. The data were collected using the VDO database and the electronic medical record database to isolate elective and emergent patient cases in which

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Benjamin L. Brown, Demetrius Lopes, David A. Miller, Rabih G. Tawk, Leonardo B. C. Brasiliense, Andrew Ringer, Eric Sauvageau, Ciarán J. Powers, Adam Arthur, Daniel Hoit, Kenneth Snyder, Adnan Siddiqui, Elad Levy, L. Nelson Hopkins, Hugo Cuellar, Rafael Rodriguez-Mercado, Erol Veznedaroglu, Mandy Binning, J Mocco, Pedro Aguilar-Salinas, Alan Boulos, Junichi Yamamoto and Ricardo A. Hanel

M icrosurgery remains the gold standard for decompression of cranial nerves (CNs) affected by aneurysmal mass effect. Over the past 2 decades, coil embolization has gained rapid acceptance as a viable alternative. For the treatment of large unruptured aneurysms of the proximal internal carotid artery, flow diversion has grown in popularity as an alternative to both microsurgery and coil embolization. Cranial nerve compression is not an uncommon presenting symptom for these aneurysms. For cavernous aneurysms, the presenting symptom is diplopia in about 65

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Robert W. Ryan, Amir S. Khan, Rebecca Barco and Armen Choulakian

Rt ICA 3 mm × 1 mm II 1 9 71 F Lt ICA <1 mm V 2 10 69 F Lt ICA 1.5 mm × 1 mm I 3 11 22 F Lt ICA 2 mm × 2 mm II 0 12 47 F Rt ICA 2 mm × 1 mm II 5 13 52 F Rt ICA 1.5 mm × 1.5 mm I 5 H & H = Hunt and Hess. Two patients underwent treatment during their initial catheter angiogram study. The remainder were returned to the neurocritical care unit after the initial study, for further discussion of flow diversion, loading of antiplatelet medications, and observation for development of hydrocephalus; these patients underwent PED treatment an average of 3.1 days later (range

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Sabareesh K. Natarajan, Ning Lin, Ashish Sonig, Ansaar T. Rai, Jeffrey S. Carpenter, Elad I. Levy and Adnan H. Siddiqui

F low diversion has proven to be an important addition to the endovascular toolbox for the treatment of anterior circulation intracranial aneurysms. 5 , 8 , 9 , 12 , 14 , 18 There has been considerable pessimism with respect to the use of flow diversion for posterior circulation aneurysms because of reports of perforator territory infarcts and delayed ruptures, including an initial case series from our center. 3–6 , 11 , 17 There have been recent reports of US single-center experiences 1 , 13 and an Australian multicenter experience 15 with posterior