{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T19:01:14Z","timestamp":1788548474034,"version":"build-2803163510"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>According to benchtop studies, the oversizing of a Pipeline embolization device (PED) relative to the parent artery leads to a significant increase in porosity and potentially compromises aneurysm occlusion as well as transitional zone (TZ) formation around the neck of aneurysms. However, no clinical assessment has been reported. Here this potential was studied by measuring the dynamic changes of PEDs in the clinical time course.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors retrospectively examined 124 anterior circulation unruptured aneurysms in 114 consecutive patients treated with a PED between July 2015 and December 2020 at their institution. The authors excluded 77 cases of 68 patients with adjunctive coil embolization or multiple stents that could affect the PED dynamics and measurements, and 47 aneurysms in 46 patients were included. Measurements were performed before, immediately after, and 6 months after treatment, and then at intervals of 6 months to 1 year after that for nonocclusion cases.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Complete occlusion was achieved in 79.0% and incomplete occlusion in 21.0% at last follow-up. The PED length immediately after deployment was 136% nominal length. A multivariable regression analysis revealed that age (OR 1.11\/year; p = 0.02) and PED elongation from nominal length (OR 1.31\/mm; p = 0.012) were independently associated with a higher rate of incomplete occlusion at the last follow-up. TZ formation did not affect the occlusion rate.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>PED elongation from the nominal length is a new predictor of incomplete aneurysm occlusion. The PED showed vascular remodeling by changing its diameter and length in the clinical course. TZ formation was remodeled and did not affect the occlusion rate.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.5.jns222403","type":"journal-article","created":{"date-parts":[[2023,7,22]],"date-time":"2023-07-22T14:49:16Z","timestamp":1690037356000},"page":"172-182","source":"Crossref","is-referenced-by-count":4,"title":["Pipeline embolization device dynamics: prediction of incomplete occlusion by elongation from nominal length"],"prefix":"10.3171","volume":"140","author":[{"given":"Tadashi","family":"Sunohara","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotoshi","family":"Imamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Ohta","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaomi","family":"Koyanagi","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Goto","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryu","family":"Fukumitsu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Fukui","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuuki","family":"Takano","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Matsuoka","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunimasa","family":"Teranishi","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuuji","family":"Naramoto","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rikuo","family":"Nishii","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiaki","family":"Sakai","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Sakai","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Neurosurgery","first-page":"1115","article-title":"Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the Pipeline embolization device","volume":"62","author":"Fiorella D","year":"2008","unstructured":"Fiorella D, Woo HH, Albuquerque FC, Nelson PK. Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the Pipeline embolization device. Neurosurgery. 2008;62(5):1115\u20131121."},{"issue":"3","key":"b2","series-title":"Neurosurgery","first-page":"443","article-title":"Pipeline embolization devices for the treatment of intracranial aneurysms, single-center registry: long-term angiographic and clinical outcomes from 1000 aneurysms","volume":"89","author":"Lylyk I","year":"2021","unstructured":"Lylyk I, Scrivano E, Lundquist J,  Pipeline embolization devices for the treatment of intracranial aneurysms, single-center registry: long-term angiographic and clinical outcomes from 1000 aneurysms. Neurosurgery. 2021;89(3):443\u2013449."},{"issue":"4","key":"b3","series-title":"J Neurosurg","first-page":"775","article-title":"Safety and efficacy of the Pipeline embolization device for treatment of intracranial aneurysms: a pooled analysis of 3 large studies","volume":"127","author":"Kallmes DF","year":"2017","unstructured":"Kallmes DF, Brinjikji W, Cekirge S,  Safety and efficacy of the Pipeline embolization device for treatment of intracranial aneurysms: a pooled analysis of 3 large studies. J Neurosurg. 2017;127(4):775\u2013780."},{"issue":"1","key":"b4","series-title":"J Neurosurg","first-page":"81","article-title":"Pipeline for uncoilable or failed aneurysms: 3-year follow-up results","volume":"127","author":"Becske T","year":"2017","unstructured":"Becske T, Potts MB, Shapiro M,  Pipeline for uncoilable or failed aneurysms: 3-year follow-up results. J Neurosurg. 2017;127(1):81\u201388."},{"issue":"1","key":"b5","series-title":"AJNR Am J Neuroradiol","first-page":"34","article-title":"The pipeline embolization device for the intracranial treatment of aneurysms trial","volume":"32","author":"Nelson PK","year":"2011","unstructured":"Nelson PK, Lylyk P, Szikora I, Wetzel SG, Wanke I, Fiorella D. The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol. 2011;32(1):34\u201340."},{"issue":"1","key":"b6","series-title":"AJNR Am J Neuroradiol","first-page":"108","article-title":"International retrospective study of the pipeline embolization device: a multicenter aneurysm treatment study","volume":"36","author":"Kallmes DF","year":"2015","unstructured":"Kallmes DF, Hanel R, Lopes D,  International retrospective study of the pipeline embolization device: a multicenter aneurysm treatment study. 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J Neurointerv Surg. 2021;13(1):86\u201390."},{"issue":"8","key":"b31","series-title":"Neuroradiology","first-page":"849","article-title":"Effects of metal coverage rate of flow diversion device on neointimal growth at side branch ostium and stented artery: an animal experiment in rabbit abdominal aorta","volume":"54","author":"Hong B","year":"2012","unstructured":"Hong B, Wang K, Huang Q,  Effects of metal coverage rate of flow diversion device on neointimal growth at side branch ostium and stented artery: an animal experiment in rabbit abdominal aorta. Neuroradiology. 2012;54(8):849\u2013855."},{"issue":"11","key":"b32","series-title":"Neuroradiology","first-page":"1355","article-title":"Endovascular treatment with flow diverters may fail to occlude experimental bifurcation aneurysms","volume":"55","author":"Raymond J","year":"2013","unstructured":"Raymond J, Darsaut TE, Makoyeva A, Bing F, Salazkin I. 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