Comparison of Flow Diversion and Coiling in Large Unruptured Intracranial Saccular Aneurysms

Abstract

Background and Purpose— Flow diversion has emerged as an important tool for the management of intracranial aneurysms. The purpose of this study was to compare flow diversion and traditional embolization strategies in terms of safety, efficacy, and clinical outcomes in patients with unruptured, large saccular aneurysms (≥10 mm). Methods— Forty patients treated with the Pipeline Embolization Device (PED) were matched in a 1:3 fashion with 120 patients treated with coiling based on patient age and aneurysm size. Fusiform and anterior communicating artery aneurysms were eliminated from the analysis. Procedural complications, angiographic results, and clinical outcomes were analyzed and compared. Results— There were no differences between the 2 groups in terms of patient age, sex, aneurysm size, and aneurysm location. The rate of procedure-related complications did not differ between the PED (7.5%) and the coil group (7.5%; P =1). At the latest follow-up, a significantly higher proportion of aneurysms treated with PED (86%) achieved complete obliteration compared with coiled aneurysms (41%; P <0.001). In multivariable analysis, coiling was an independent predictor of nonocclusion. Retreatment was necessary in fewer patients in the PED group (2.8%) than the coil group (37%; P <0.001). A similar proportion of patients attained a favorable outcome (modified Rankin Scale, 0–2) in the PED group (92%) and in the coil group (94%; P =0.8). Conclusions— The PED provides higher aneurysm occlusion rates than coiling, with no additional morbidity and similar clinical outcomes. These findings suggest that the PED might be a preferred treatment option for large unruptured saccular aneurysms.

Pipeline embolization device for recurrence of previously treated aneurysms

“…When combined with those demonstrating near-complete occlusion (> 90%), this increased to 86.7% and 100%, respectively, consistent with radiographic outcomes for PED placement in untreated aneurysms 6 and with those seen in microsurgical clipping. 24 Similarly, among those patients treated with a PED following endovascular coiling at our institution, 80% demonstrated complete occlusion at 6 months, and 100% demonstrated complete occlusion at 1 year.…”

“…With complete obliteration of 86% and retreatment only seen in 2.8% of patients, PED outcomes are similar to those observed in microsurgical clipping and significantly improved in comparison with other endovascular therapies. 6 Despite the highly efficacious results, the role of PED utilization in the setting of recurrent aneurysms has not yet been well defined. This study assesses the safety and efficacy of PED as a second-line treatment for aneurysm recurrence following endovascular or microsurgical treatment.…”

Pipeline Embolization Device in the Treatment of Recurrent Previously Stented Cerebral Aneurysms

“…The rate of complete aneurysm occlusion was significantly low (55.6%), especially compared with the high success rate of PED treatment reported in this study for subjects without prior stent placement (80.4%) and in other studies, with most reporting a high occlusion rate of Ͼ80%. [12][13][14]19 In addition, the rate of retreatment (11.1%) was considerably higher than that reported with PED treatment of nonstented aneurysms. Zanaty et al 13 reported a 5% rate of retreatment after PED placement.…”

“…11,12 The overall use of the PED has gained popularity mainly because of its high success rate in achieving aneurysm occlusion and low aneurysm recurrence and retreatment rates, especially compared with other endovascular interventions. 13,14 Early reports have questioned the efficacy and safety of the PED in treating previously stented aneurysms. [15][16][17] The aim of this study was to evaluate the role of the PED, both its efficacy and safety, in the treatment of recurrent, previously stented cerebral aneurysms.…”

Mid-Term Outcome Following Pipeline Embolization of Unruptured Intracranial Aneurysms

“…Chalouhi et al compared the use of coiling vs. PED in a series of patients with large saccular aneurysms and found significantly higher aneurysmal occlusion and significantly less necessity for retreatment, while the morbidity rate did not differ between the two groups (13).…”