{
  "abstract": "Background The pipeline embolization device (PED) has been increasingly used to treat brain aneurysms; however, concerns have been raised about braid stability with newer drawn filled tubing technology devices.Objective To evaluate braid stability of PED early generations using data from the PREMIER trial.Methods All consecutive intracranial aneurysms treated with PED (Classic and Flex) within the PREMIER trial were reviewed for braid stability (fish mouthing, foreshortening, braid bump, braid collapsing). Immediate postprocedure cone-beam CT and angiography were compared with 1- and 2- years' follow-up. Analyses included safety, measured with the modified Rankin Scale (mRS) score, including +1 mRS point and a good clinical outcome (mRS score 0–2), vessel stenosis ≥50%, effectiveness measured with Raymond-Roy Scale, and re-treatment rates.Results 133/141 aneurysms had a complete dataset. 8/133 (6%) aneurysms showed braid deformations. Inter-reader agreement was excellent (κ=0.83). Braid deformations were statistically significantly associated with in-stent vessel stenosis >50% (P=0.029), without impact on effectiveness or safety. Fish mouthing was found in 1/133 (0.75%) at 1 year, causing >50% vessel stenosis. Foreshortening occurred in 6/133 (4.5%), and braid bump in 1/133 (0.75%) associated with severe in-stent stenosis. Four other cases (3.0%) of asymptomatic in-stent stenosis due to neointimal hyperplasia were seen without braid changes. No new braid stability deformations were found at the 2-year follow-up.Conclusion Our study demonstrates excellent braid stability among patients treated with the PED Classic and Flex in the PREMIER trial. Within the uncommon braid changes observed, none affected the PED safety or efficacy.Trial registration number NCT02186561.",
  "authors": [
    {
      "affiliations": [
        "Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA",
        "Research Department, Jacksonville University, Jacksonville, Florida, USA"
      ],
      "name": "Fernanda Rodriguez-Erazú"
    },
    {
      "affiliations": [
        "Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA",
        "Department of Neurological Surgery, Mount Sinai Health System, New York, New York, USA"
      ],
      "name": "Gustavo M Cortez"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA"
      ],
      "name": "Demetrius K Lopes"
    },
    {
      "affiliations": [
        "Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA",
        "Research Department, Jacksonville University, Jacksonville, Florida, USA"
      ],
      "name": "Salvador F Gutierrez-Aguirre"
    },
    {
      "affiliations": [
        "Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA",
        "Research Department, Jacksonville University, Jacksonville, Florida, USA"
      ],
      "name": "Otavio Frederico De Toledo"
    },
    {
      "affiliations": [
        "Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA"
      ],
      "name": "Amin Aghaebrahim"
    },
    {
      "affiliations": [
        "Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA"
      ],
      "name": "Eric Sauvageau"
    },
    {
      "affiliations": [
        "Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "David F Kallmes"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany"
      ],
      "name": "Jens Fiehler"
    },
    {
      "affiliations": [
        "Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA"
      ],
      "name": "Ricardo A Hanel"
    }
  ],
  "title": "Braids and beyond: a comprehensive study on pipeline device braid stability from PREMIER data",
  "uid": "739e0f53-10cc-5079-972f-aabd3b0815ab"
}