BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PIPELINE EMBOLIZATION DEVICE

    MDR report key: 6448692 · Received March 30, 2017

    Report

    Report Number
    2029214-2017-00300
    Event Type
    Injury
    Date Received
    March 30, 2017
    Date of Event
    January 6, 2017
    Report Date
    March 3, 2017
    Manufacturer
    COVIDIEN (IRVINE)
    Product Code
    OUT
    PMA / PMN Number
    P100018.S004
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    HEALTH PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    CITATION: MATTHEW B. POTTS, MD, MAKSIM SHAPIRO, MD, DANIEL W. ZUMOFEN, MD, EYTAN RAZ, MD, EREZ NOSSEK, MD, KEITH G. DESOUSA, MD, TIBOR BECSKE, MD, HOWARD A. RIINA, MD, AND PETER K. NELSON, MD. PARENT VESSEL OCCLUSION AFTER PIPELINE EMBOLIZATION OF CEREBRAL ANEURYSMS OF THE ANTERIOR CIRCULATION. J NEUROSURG JANUARY 6, 2017 THE DEVICE WAS NOT RETURNED AS IT WAS IMPLANTED IN THE PATIENT; THEREFORE, PRODUCT ANALYSIS OF THE PIPELINE DEVICES WAS NOT ABLE TO BE PERFORMED. THE MODEL AND LOT NUMBERS OF THE PIPELINE EMBOLIZATION DEVICES IMPLANTED WERE NOT REPORTED IN THE ARTICLE. ADDITIONAL INFORMATION HAS BEEN REQUESTED FROM THE MAIN AUTHOR OF THIS ARTICLE, HOWEVER NO FURTHER INFORMATION HAS BEEN PROVIDED. SHOULD THE REQUESTED INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. THE AUTHORS PERFORMED A RETROSPECTIVE REVIEW OF ALL ANTERIOR CIRCULATION ANEURYSMS CONSECUTIVELY TREATED AT A SINGLE INSTITUTION WITH THE PED THROUGH 2014, IDENTIFYING THOSE WITH PVO ON FOLLOW-UP IMAGING. THE CAUSES OF PVO IN THIS SERIES WERE NOT CONFIDENTLY IDENTIFIED BY THE AUTHORS. THE AUTHORS NOTE THAT THE CASES OF DELAYED PVO IN THE LITERATURE HAVE BEEN REPORTED TO OCCUR SOON AFTER DISCONTINUATION OF CLOPIDOGREL, EITHER AS PRESCRIBED BY THE TREATING PHYSICIANS BASED ON MEDICAL NECESSITY OR FOLLOW-UP IMAGING 6,9,13 OR WHEN SELF-DISCONTINUED BY PATIENT. BASED ON THE REPORTED INFORMATION, THERE DID NOT APPEAR TO HAVE BEEN ANY DEFECT OF THE DEVICE DURING USE. AFTER REVIEWING THE IFU, AND REVIEW OF LITERATURE TO INVESTIGATE THE COMPLAINT, THE MOST LIKELY CAUSE FOR THE COMPLAINT IS RELATED TO THE PATIENT CONDITION. REFERENCE OTHER MDRS 2029214-2017-00298, 2029214-2017-00299, 2029214-2017-00297 FOR THIS SUBJECT. OTHER MDRS FROM THIS LITERATURE REVIEW: 2029214-2017-00295, 2029214-2017-00296, 2029214-2017-00301, 2029214-2017-00302, 2029214-2017 -00303 2029214-2017-00304, 2029214-2017-00305, 2029214-2017-00306, 2029214-2017-00307, 2029214-2017-00308, 2029214-2017-00309, 2029214-2017 -00310, 2029214-2017-00311, 2029214-2017-00312, 2029214-2017-00313 2029214-2017-00314, 2029214-2017-00315, 2029214-2017-00316, 2029214-2017-00317, 2029214-2017-00318, 2029214-2017-00319, 2029214-2017 -00320, 2029214-2017-00321, 2029214-2017-00322, 2029214-2017-00323 2029214-2017-00324, 2029214-2017-00325, 2029214-2017-00326 2029214-2017-00327, 2029214-2017-00328, 2029214-2017-00329. A GOOD FAITH EFFORT WILL BE MADE TO OBTAIN THE APPLICABLE INFORMATION RELEVANT TO THE REPORT. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Additional Manufacturer Narrative · 1

    IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

    Description of Event or Problem · 1

    MEDTRONIC RECEIVED INFORMATION THROUGH LITERATURE REVIEW THAT THIS PATIENT EXPERIENCED ASYMPTOMATIC PARENT VESSEL OCCLUSION (PVO) AFTER PIPELINE EMBOLIZATION PROCEDURE. THE PVO WAS DISCOVERED ON ROUTINE FOLLOW-UP IMAGING AT 12 MONTHS. THERE WAS NO NEW PERMANENT NEUROLOGICAL DEFICIT AND THE GOAL OF COMPLETE ANEURYSM OCCLUSION WAS ACHIEVED. THERE WAS COLLATERAL SUPPLY TO THE OCCLUDED ICA TERRITORY THROUGH THE CIRCLE OF WILLIS¿VIA THE ANTERIOR COMMUNICATING ARTERY AND THE IPSILATERAL POSTERIOR COMMUNICATING ARTERY. THIS (B)(6) FEMALE PATIENT PRESENTED WITH CRANIAL NERVE III/IV PALSIES OF THE RIGHT EYE AND HORNER¿S SYNDROME. THE PATIENT WAS FOUND TO HAVE A GIANT RIGHT CAVERNOUS ICA ANEURYSM WITH THE NECK MEASURING 12MM WITH A DOME OF 32MM. THIS PATIENT RECEIVED CLOPIDOGREL, 75 MG DAILY, FOR 7 DAYS PRIOR TO EMBOLIZATION AND ASPIRIN, 325 MG DAILY, FOR 2 DAYS PRIOR TO EMBOLIZATION WITHOUT PRE- OR POSTPROCEDURAL PLATELET FUNCTION TESTING. THIS PROCEDURE WAS PERFORMED PRIOR TO P2Y12 PLATELET FUNCTIONAL TESTING BECAME AVAILABLE. THE PATIENT UNDERWENT PIPELINE EMBOLIZATION USING 4 TELESCOPING PEDS. DUE TO VESSEL STENOSIS WITHIN THE PROXIMAL ICA, BALLOON DILATATION WAS PERFORMED DURING EMBOLIZATION. IMMEDIATE POST EMBOLIZATION ANGIOGRAM OF THE RIGHT ICA IN NATIVE AND SUBTRACTED VIEWS SHOWED STAGNATION OF CONTRAST WITHIN THE ANEURYSM SAC. UPON DISCHARGE THE PATIENT WAS PRESCRIBED A MINIMUM OF 6 MONTHS OF DUAL ANTIPLATELET THERAPY (DAPT) WITH ASPIRIN AND CLOPIDOGREL. THE DECISION TO STOP OR EXTEND THE COVERAGE WERE SUBSEQUENTLY BASED ON THE RESULTS OF FOLLOW UP ANGIO. SIX MONTH FOLLOW UP DIGITAL SUBTRACTION (DS) ANGIOGRAM OF THE RIGHT ICA SHOWED A COMPLETE OCCLUSION OF THE ANEURYSM WITH MINIMAL INTIMAL HYPERPLASIA WITHIN THE PIPELINE CONSTRUCT. ONE-YEAR FOLLOW-UP DS ANGIOGRAM OF THE RIGHT COMMON CAROTID ARTERY (CCA) SHOWED COMPLETE OCCLUSION OF THE PROXIMAL RIGHT ICA. FIVE-YEAR FOLLOW-UP DS ANGIOGRAM OF THE RIGHT CCA AND LEFT ICA SHOWED PERSISTENT COMPLETE OCCLUSION OF THE RIGHT ICA WITH COLLATERAL FILLING OF THE RIGHT HEMISPHERE THROUGH THE ANTERIOR COMMUNICATING ARTERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    230622 PIPELINE EMBOLIZATION DEVICE INTRACRANIAL ANEURYSM FLOW DIVERTER OUT COVIDIEN (IRVINE) UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Other