Clinical outcomes of pipeline embolization devices with shield technology for treating intracranial aneurysms

Abstract

IntroductionAs a common endovascular treatment for intracranial aneurysms, the pipeline embolization device (PED) is considered a standard treatment option, especially for large, giant, wide-necked, or dissecting aneurysms. A layer of phosphorylcholine biocompatible polymer added to the surface of the PED can substantially improve this technology. This PED with shield technology (pipeline shield) is relatively novel; its early technical success and safety have been reported. We conducted a systematic literature review with the aim of evaluating the efficacy and safety of the pipeline shield.MethodsWe searched the PubMed, Embase, and Cochrane databases, following the preferred reporting items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.ResultsWe selected five prospective and two retrospective studies for review. A total of 572 aneurysms were included; of these, 506 (88.5%) were unruptured. The antiplatelet regimens were heterogeneous. The rate of perioperative and postoperative complications was 11.1% [95% confidence interval (CI): 6.5–18.9%]. The adequate occlusion rate at 6 months was 73.9% (95% CI: 69.1–78.7%). The adequate occlusion rate of more than 12 months was 80.9% (95% CI: 75.1–86.1%). The mortality rate was 0.7% (95% CI: 0.2–1.5%). Subgroup analyses showed that aneurysm rupture status had no effect on aneurysm occlusion rate, patient morbidity, or mortality.ConclusionThis review demonstrates the safety and efficacy of the pipeline shield for treating intracranial aneurysms. However, direct comparisons of the pipeline shield with other flow diverters are needed to better understand the relative safety and effectiveness of different devices.

Comparison of Thromboembolic Events Between Pipeline Embolization Device (PED) Shield and PED/PED Flex: A Propensity Score–Matched Analysis

“…These findings were consistent with the rates of complications reported in other large PED series, such as the PFLEX study, 12 PREMIER, 21 or IntrePED, 22 and Chinese cohorts, 23 validating the noninferiority and safety of the Shield technology. 24-26 However, it should be noted that some of the ischemic events are silent, and a prospective routine imaging analysis using diffusion-weight imaging (DWI) has indicated that ischemic lesions may occur in up to 16.6% of procedures, 27 potentially even higher in some analyses. 28,29 Nonetheless, other case series have shown DWI changes in patients after cerebral angiography posing limitations when attributing those changes solely to the FD.…”

Trends in Dual Antiplatelet Therapy Use for Neurointerventional Procedures for the Management of Intracranial Aneurysms

“…To minimize the requirements for DAPT, a new FDS with a hydrophilic polymer coating (p48-MW-HPC) has been developed. This has a similar goal to the novel PED-Shield: a FDS with a phosphorylcholine coating designed to reduce thrombogenicity [ 67 ]. Either of these devices may be preferred in cases of ruptured aneurysms due to the reduced need for antiplatelet agents [ 67 ].…”

“…This has a similar goal to the novel PED-Shield: a FDS with a phosphorylcholine coating designed to reduce thrombogenicity [ 67 ]. Either of these devices may be preferred in cases of ruptured aneurysms due to the reduced need for antiplatelet agents [ 67 ]. Lobsien et al demonstrated the effectiveness of the p48-MW-HPC FDS under SAPT across 13 ruptured aneurysms and reported a single thromboembolic complication [ 68 ].…”

Radiological findings and endovascular management of internal carotid artery pseudoaneurysm in the setting of mucormycosis and COVID-19

“…The Pipeline with Shield Technology helps to reduce the use of antiplatelet drugs in patients who have nasal bleeds. 36 , 37 …”