P-021 Multi-center case series of 33 patients with ruptured internal carotid artery blister pseudoaneurysms treated with phosphorylcholine surface-modified flow diverter
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".