RESUMO
BACKGROUND: The development of ischemic events is relatively common after endovascular interventions, and flow diverters may pose a particular threat owing to their increased technical complexity and high metal content. OBJECTIVE: To investigate the incidence and potential risk factors for thromboembolic lesions after treatment with a Pipeline embolization device (PED). METHODS: This prospective study included a total of 59 patients electively treated with a PED over 12â months. Postprocedural diffusion-weighted imaging sequences of the brain were obtained 24â h after interventions to detect ischemic lesions. Demographic data, aneurysm characteristics, antiplatelet management, and perioperative data were correlated with the rate of ischemic events. RESULTS: The incidence of silent ischemic events after use of a PED was 62.7% (37 patients) and neurological symptoms occurred in 8.1% of affected patients. Development of ischemic events was significantly associated with older patients (≥60â years; p=0.038). Routine use of platelet function assays and newer P2Y12 receptor inhibitors (ticagrelor) were not associated with fewer thromboembolic events. CONCLUSIONS: Thromboembolic events are relatively common after treatment with a PED with an incidence comparable to stent-assisted and conventional coiling but the risk of neurological morbidity from ischemic burden is low. Older patients are at particularly increased risk of thromboembolic events.