P-021 Multi-center case series of 33 patients with ruptured internal carotid artery blister pseudoaneurysms treated with phosphorylcholine surface-modified flow diverter
Notice bibliographique
Résumé
Objective Ruptured blister, dissecting, and iatrogenic pseudoaneurysms are rare pathologies that pose significant challenges from a treatment standpoint. Endovascular treatment via flow diversion represents an increasingly popular option; however, drawbacks include the requirement for dual antiplatelet therapy and the potential for thromboembolic complications, particularly acutely in the ruptured setting. The Pipeline Flex Embolization device with Shield technology (PED-Shield) offers a reduced material thrombogenicity via coating with phosphorylcholine, which may aid in the treatment of ruptured internal carotid artery pseudoaneurysms. Methods The authors conducted a multi-institution, retrospective case series to determine the safety and efficacy of PED-Shield in the treatment of ruptured blister, dissecting, and iatrogenic pseudoaneurysms of the internal carotid artery. Clinical, radiographic, treatment, and outcomes data were collected. Results Thirty-three patients were included in the final analysis. Seventeen underwent placement of a single device and 16 underwent placement of two devices. Adjunctive coiling was conducted in two cases. Four patients were maintained on aspirin alone and all others were treated with long-term dual antiplatelet therapy. No thromboembolic complications occurred. Among patients with 3-month follow-up, 93.8% had an modified Rankin Scale score of 0-2. Overall complete occlusion at follow-up was observed in 82.6% of patients. Among patients treated with multiple telescoping devices, complete occlusion was observed in 90.9% of cases, while those treated with a single device demonstrated complete occlusion in 72.7% of cases. Extremely early complete occlusion (observed in less than one month post-operatively) was observed in five patients. Of the five patients, four underwent placement of multiple telescoping devices, while the remaining one was treated with a single device. Conclusions PED-Shield represents a new option for treatment of ruptured blister, dissecting, and iatrogenic pseudoaneurysms of the internal carotid artery, and the presented work represents the largest series to date describing treatment of this pathology with PED-Shield. The reduced material thrombogenicity appears to improve the safety of the PED-Shield device, as our series demonstrated no thromboembolic complications, even among patients treated with only single antiplatelet therapy. The efficacy of the PED-Shield reported in this series, particularly with placement of two devices, demonstrates its potential as a first-line treatment option for these pathologies. Disclosures M. Bounajem: None. E. Joyce: None. J. Scoville: None. J. Seinfeld: 2; C; Medtronic. J. Hoffman: None. J. Grossberg: 1; C; GRA, EMFC, Neurosurgery Catalyst. 4; C; Cognition. V. Waiters: None. A. White: None. J. Nerva: 4; C; Midwest Interventional Systems Inc, Synchron LLC, Bendit Technologies Ltd, Borvo Medical. J. Burkhardt: 2; C; Microvention, Cerenovus, Stryker, Medtronic, Longeviti Neuro Solutions, Q`Apel Medical. D. Tonetti: None. K. El Naamani: None. M. Gooch: 2; C; Stryker. P. Jabbour: 1; C; Medtronic. S. Tjoumakaris: 6; C; Microvention. S. Ortega Gutierrez: 6; C; Stryker, Medtronic, Microvention. M. Levitt: 1; C; Medtronic, Stryker. 2; C; Metis Innovative, Aeaean Advisers, Stereotaxis. 6; C; Prioprio, Hyperion Surgical, Synchron, Fluid Biomed, Cerebrotech. M. Lang: None. W. Ares: None. S. Desai: None. J. Mascitelli: 2; C; Stryker. C. Kilburg: 6; C; Medtronic, Cerenovus. K. Budohoski: None. W. Couldwell: None. B. Gross: 2; C; Medtronic, Microvention, Stryker. R. Grandhi: 6; C; Medtronic, Cerenovus, Balt.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».