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Neurosurgery. 2017 Apr 1;80(4):579-587. doi: 10.1227/NEU.0000000000001377.

Pipeline Embolization Device for Small Intracranial Aneurysms: Evaluation of Safety and Efficacy in a Multicenter Cohort.

Author information

1
Neurosurgical Service, Beth Israel Dea-coness Medical Center, Harvard Medic-al School, Boston, Massachusetts.
2
Dep-artment of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama.
3
Harvard Medical School, Bost-on, Massachusetts.
4
Department of Neur-osurgery, Vanderbilt University, Nashville, Tennessee.
5
Department of Neurosu-rgery, Mount Sinai Hospital, New York, New York.
6
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
7
Department of Neurosurgery, Univ-ersity at Buffalo, Buffalo, New York.

Abstract

BACKGROUND:

To date, the use of the flow-diverting Pipeline Embolization Device (PED) for small intracranial aneurysms (≤ 7 mm) has been reported only in single-center series.

OBJECTIVE:

To evaluate the safety and efficacy of the PED in a multicenter cohort.

METHODS:

Five major academic institutions in the United States provided data on patient demographics, aneurysm features, and treatment characteristics of consecutive patients with aneurysms ≤ 7 mm treated with a PED between 2009 and 2015. Radiographic outcome was assessed with digital subtraction angiography. Clinical outcome was measured with the modified Rankin Scale.

RESULTS:

The cumulative number of aneurysms ≤ 7 mm treated with PED at the 5 institutions was 149 in 117 patients (age, 54 years [range, 29-87 years]; male to female, 1-5.9). Aneurysms were most commonly located in the paraophthalmic segment (67.1%) of the internal carotid artery. Radiographic outcome at last follow-up was available for 123 aneurysms (82.6%), with a complete occlusion rate of 87%. Thromboembolic and symptomatic procedural complications occurred in 8.7% and 6% of the aneurysms treated, respectively. There was 1 mortality (0.9%) unrelated to the PED procedure. Multivariable logistic regression identified size < 4 mm, balloon angioplasty to open the device, and simultaneous treatment of multiple aneurysms as predictors of procedural complications. Good clinical outcome was achieved in 96% of electively treated patients.

CONCLUSION:

In the largest series on PED for small aneurysms to date, data suggest that treatment with the flow-diverting PED is safe and efficacious, with complication rates comparable to those for traditional endovascular techniques.

KEYWORDS:

Aneurysm; Embolization; Endovascular; Intracranial; Pipeline embolization device; Small

PMID:
27489165
DOI:
10.1227/NEU.0000000000001377
[Indexed for MEDLINE]

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