Long-term results and comparison of flow re-direction endoluminal device and pipeline embolization device in endovascular treatment of intracranial carotid aneurysms

Abstract

Objective This study aims to compare the efficacy, safety, and long-term outcomes of two flow diverters, i.e., pipeline embolization device and flow re-direction endoluminal device, in the treatment of distal carotid aneurysms. Methods A total of 138 patients with 175 aneurysms were included from February 2012 to September 2019. Ninety-nine aneurysms were treated with flow re-direction endoluminal device and 76 with pipeline embolization device. Angiographic follow-ups were at the 6th, 12th, 24th, 36th, and 60th months; the O’Kelly-Marotta grading scale was used to assess aneurysms occlusion. Outcomes of two devices were compared; possible associations regarding patient characteristics, aneurysm properties, treatment details, and adverse events were evaluated. Results The mean follow-up period was 33 months, with 10 patients lost to follow-up. Occlusion rates at the 6th and 12th months and during the last follow-up were similar for flow re-direction endoluminal device (81%, 84%, and 90%) and pipeline embolization device (82%, 85%, and 93%). Occlusion rates were also similar after stand-alone use without coiling. There was no significant difference regarding adverse event rates with a 10.9% overall complication rate, 3.6% mortality, and 0.7% permanent morbidity. All the mortality and morbidity were related to hemorrhagic complications. Device deployment failure was observed with five flow re-direction endoluminal devices and two pipeline embolization devices, whereas two severe in-stent stenoses occurred with each device. Conclusions Both flow re-direction endoluminal device and pipeline embolization device are feasible and effective in flow diversion of distal internal carotid artery aneurysms, with similar adverse events rates and aneurysm occlusion success. Aneurysm occlusion rates increase with time, while the presence of an integrated branch significantly decreases treatment success.

Comparison of Flow-Redirection Endoluminal Device and Pipeline Embolization Device in the Treatment of Intracerebral Aneurysms

“…All the complications in the FRED group were cases of mild in-stent stenosis, the rate of which was double than that experienced in the PED group (15.2% vs 6.9%; OR = 2.411). This corroborates the findings presented in the study by Gündogmus ¸et al 16 where all 5 case of instent stenosis were observed in the FRED-treated group compared with none in the PED group. In their study, 2 patients treated with FRED developed asymptomatic but severe in-stent stenosis after 1 year, 1 of which progressed to asymptomatic total occlusion by the second year.…”

“…To the best of our knowledge, there are only 3 studies in the literature comparing the only 2 FDA-approved flow-diverting stents, FRED and PED. 4,15,16 Our IPW-adjusted study represents the only study directly comparing both flow diverters in the treatment of anterior and posterior circulation aneurysms at a single institution in the United States. No statistically significant differences in complete occlusion rates at 6 months, functional outcome, length of stay, or complication rate were found between the 2 groups.…”

Commentary: Comparison of Flow-Redirection Endoluminal Device and Pipeline Embolization Device in the Treatment of Intracerebral Aneurysms

“…Post-treatment complications, specifically in FRED-treated cohort, although reported as mild, are similar to what has been previously reported in the study by Gündogmus et al 3 where in-stent stenosis was observed only in the FRED-treated group compared with none in the PED group. Studies by Hagen et al 15 and Girdhar et al 16 examined the thrombogenicity of PED and FRED in ex-vivo and in vitro models with and without antiplatelet medication and dual antiplatelet therapy.…”

“…[5][6][7] By doing this, they make it possible to repair the parent artery's mural insufficiency, occluding the aneurysm permanently and resolving it over. [1][2][3][4][5]8,9 The 2 Food and Drug Administration-approved flow diverters, pipeline embolization device (PED) and flow redirection endoluminal device (FRED), have demonstrated excellent results in treating unruptured aneurysms in numerous studies conducted internationally, enabling minimally invasive therapy of intracranial aneurysms. [2][3][4][7][8][9][10][11][12][13] The potential for these devices to target and treat aneurysms of diverse sizes, shapes, and even different cerebral sites that have not yet been thoroughly submitted to prospective investigation is quite promising.…”

“…nruptured intracranial aneurysms are rather common lesions that are now being diagnosed early as a result of the expansion of noninvasive intracranial vascular imaging techniques. [1][2][3][4][5] With the advent of flow diversion therapy during the past few decades, the goal of endovascular aneurysm treatments has changed conceptually from parent vessel sacrifice or coil packing of the aneurysm fundus to endoluminal restoration of the parent vessel using flow diverters. 1,[5][6][7] The endoluminal devices used for this purpose change the nature of fluid exchange between the aneurysm and parent artery, which consequently facilitates aneurysmal sac thrombosis.…”