Abstract WP82: Transcranial Doppler Detection of Microembolic Signals During the Advancement and Deployment of Pipeline Embolization Devices in Unruptured Intracranial Aneurysm Repair

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Introduction: Pipeline embolization devices (PED) have become an essential tool in the endovascular treatment of complex intracranial aneurysms. A high-density stent like device, the PED functions to redirect blood flow and facilitate the growth and remodeling of the artery. Postoperative ischemic stroke proves to be the most common neurological complication associated with treatment, ranging from about 3-6% with most occurring within 30 days. Transcranial Doppler (TCD) monitoring has been used in the past to evaluate similar procedures by measuring the occurrence of microembolic signals (MES). Due to the delivery and manipulation of the PED and its thrombotic nature, microembolic events have been postulated to form during device placement and contribute to thromboembolism. Our initial study is the first to detect and measure MES during a PED procedure.Methods: Patients undergoing endovascular PED treatment were simultaneously monitored with TCD. MES were detected, separated from artifacts, and counted for each step.Results: Embolic signals were detected in all patients and were highest during deployment. With 3 PED deployments in the paraophthalmic ICA of 2 patients, the mean MES during PED deployment was 515 +/- 46. Average emboli per second during deployment was 1.62 +/- 0.59 verses 0.30 +/- 0.12 emboli per second observed prior to microcatheter insertion and manipulation.Conclusion: A very high incidence of MES was observed during the procedure and PED deployment. The little success thus far in elucidating a possible mechanism to account for PED’s associated complications warrants more investigation. Determining the occurrence of MES might reveal insight into the relative safety of each step and on the formation of distal thromboembolisms.

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