Exploring the Feasibility of Pipeline Embolization Device Compared With Stent-Assisted Coiling to Treat Non-saccular, Unruptured, Intradural Vertebral Artery Aneurysms

Abstract

Object: The pipeline embolization device (PED) has been used to treat non-saccular, unruptured, intradural vertebral artery aneurysms at some institutions. However, there is an absence of large controlled studies validating the feasibility of this treatment. This study aimed to explore the therapeutic feasibility of PED by comparing PED treatment with controlled stent-assisted coiling (SAC). Materials and Methods: Thirty-two PED procedures were matched in a 1:2 manner with 64 SAC procedures based on patient age, sex, aneurysm size, and aneurysm location. Technical factors, procedural complications, angiographic results, and clinical outcomes were analyzed and compared. Results: There was no statistically significant difference in technical factors and procedural complications between the two groups (PED vs. SAC, 9.4 vs. 4.7%, P = 0.397). In multivariate analysis, smoking and therapeutic modality were identified as independent predictors of occlusion. Smoking was a risk factor for aneurysm obliteration [hazard ratio (HR) 0.53; 95% confidence interval (CI), 0.31–0.89; P = 0.018]. Aneurysms treated with PED were more likely to achieve obliteration over time compared with aneurysms treated with SAC (HR 2.97; 95% CI, 1.79–4.93; P < 0.001). The rate of favorable clinical outcomes (modified Rankin Scale (mRS), 0–2) was similar between the two groups (PED vs. SAC, 100 vs. 96.9%, P = 0.551). In the SAC group, one patient had neurological deficit with an mRS of four at the latest follow-up. There was no mortality in either group. Conclusions: The PED and SAC groups showed similar technical factors, procedural complications, angiographic results, and favorable clinical outcomes. Aneurysms treated with PED were more prone to obliteration over time than aneurysms treated with SAC. These outcomes suggest, based on short-term follow-up, PED is a safe and feasible strategy for the treatment of non-saccular, unruptured, intradural vertebral artery aneurysms.

Efficacy and safety of flow diverters in posterior circulation aneurysms and comparison with their efficacy in anterior circulation aneurysms: A systematic review and meta-analysis

“…We assessed the full text of 111 studies and excluded 97 based on criteria. Finally, 14 studies 12,[18][19][20][21][24][25][26][27][28][29][30][31][32] were included for meta-analysis. Figure 1 shows a flow diagram of the study selection process.…”

“…18,31 Eight studies were multicenter and six were single-center case series. Thirteen studies 12,[18][19][20][21][24][25][26][27][28][29]31,32 reported aneurysm occlusion rates and all reported procedurerelated neurological complication rates. Our meta-analysis included a total of 659 patients with 676 posterior circulation aneurysms treated with FDs.…”

“…Moreover, eight studies 12,[24][25][26][29][30][31][32] reported data regarding the need for adjunctive coiling in addition to FD deployment. Overall, 22% (95% CI, 17-27) required adjunctive coiling (Figure 5).…”

Treatment of Unruptured Vertebral Artery Aneurysm Involving Posterior Inferior Cerebellar Artery With Pipeline Embolization Device

“…In addition, complete occlusion also occurred in three PAOs without any recanalization and recurrence. Likewise, Zhang et al (21) report 93.3% nearly complete and complete occlusion rate of unruptured vertebral no-saccular aneurysm after PED placement in 32 cases series (21). Kuhn et al (10) reported 100% nearly complete and complete occlusion rate in six patients with unruptured vertebral aneurysms.…”

Neck Location on the Outer Convexity is a Predictor of Incomplete Occlusion in Treatment with the Pipeline Embolization Device: Clinical and Angiographic Outcomes

“…9 Several factors such as age, sex, smoking, fusiform-type aneurysms, small aspect ratios, and dome-neck ratios have been reported to be predictors of incomplete or complete occlusion. [10][11][12][13][14][15][16][17] However, there is debate about outcomes when using these factors because of limited analysis of the confounding factors. Moreover, the follow-up imaging rate of incomplete occlusion is sometimes insufficient (around 50% at 6 months).…”