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Neurosurgery. 2019 Mar 12. pii: nyz059. doi: 10.1093/neuros/nyz059. [Epub ahead of print]

The Pipeline Embolization Device: Changes in Practice and Reduction of Complications in the Treatment of Anterior Circulation Aneurysms in a Multicenter Cohort.

Author information

1
Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
2
Department of Medical Imaging, University of Toronto, Toronto, Canada.
3
Department of Neurosurgery, Geisinger Health System, Geisinger School of Medicine, Danville, Pennsylvania.
4
Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama.
5
Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York.

Abstract

BACKGROUND:

The Pipeline Embolization Device (PED; Medtronic, Dublin, Ireland) has become an important tool for the treatment of cerebral aneurysms. Since FDA approval, there are ongoing efforts to increase aneurysm occlusion rates and reduce the incidence of complications.

OBJECTIVE:

To assess aneurysm occlusion and complication rates over time.

METHODS:

Retrospective analysis of consecutive anterior circulation aneurysms treated with a single PED between 2011 and 2016 at 3 academic institutions in the US was performed. Factors contributing to changes in aneurysm occlusion and complication rates over time were identified and evaluated.

RESULTS:

A total of 284 procedures were performed on 321 anterior circulation aneurysms in 284 patients. At a median follow-up of 13 mo (mean 18 mo), complete or near complete occlusion (>90%) was achieved in 85.9% of aneurysms. There was no significant change in aneurysm occlusion rate or procedure length over time. Thromboembolic complication occurred in 8.1% of procedures, and there was a trend toward decreased incidence from 16.3% in 2011/2012 to 3.3% in 2016 (P = .14). Hemorrhagic complications significantly decreased from 8.2% in 2011/2012 to 0 to 1.0% in 2014-2016 (P = .1).

CONCLUSION:

We report a notable drop in the rate of hemorrhagic and to a lesser extent thromboembolic complications with increased experience with PED in a multicenter cohort. Multiple factors are believed to contribute to this drop, including the evolved interpretation of platelet function testing, the switching of clopidogrel nonresponders to ticagrelor, and the reduced use of adjunctive coiling.

KEYWORDS:

Aneurysm; Hemorrhagic; Intracranial; Occlusion; Pipeline; Thromboembolic

PMID:
30860254
DOI:
10.1093/neuros/nyz059

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