Pipeline Embolization Device for Small Intracranial Aneurysms: Evaluation of Safety and Efficacy in a Multicenter Cohort

Griessenauer, Christoph J.; Ogilvy, Christopher S.; Foreman, Paul M.; Chua, Michelle; Harrigan, Mark R.; He, Lucy; Fusco, Matthew R.; Mocco, J; Stapleton, Christopher J.; Patel, Aman B.; Sonig, Ashish; Siddiqui, Adnan H.; Thomas, Ajith J.

doi:10.1227/neu.0000000000001377

Cited by 64 publications

(42 citation statements)

References 31 publications

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“…Important to note is that the rates of complications seen after PED placement (16%), coiling (9%), and clipping (17%) are comparable to those reported from previous studies. 17,21,26 Other studies have found similar selection bias as a result of the evolving usage of PEDs. 26 Other trends in our cohort could be sources of confounding.…”

Section: Discussionmentioning

confidence: 79%

“…Previous studies focused on the treatment of large and giant wide-necked aneurysms between the petrous and cavernous segments of the ICA, for which the PED was approved originally. 4,6,24,37,40,46 These promising results led to increasing off-label use of the PED for aneurysms that are not large and not wide necked, and several groups have found similarly strong results after treating small aneurysms 11,17,26 and other off-label applications. 2,10,13,28,32,36 Still, the number of studies on use of the PED to treat small aneurysms has been limited, and very few have directly compared patient outcomes with those of patients after coiling or clipping.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of flow diversion with clipping and coiling for the treatment of paraclinoid aneurysms in 115 patients

Silva

See

Khandelwal

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Paraclinoid aneurysms represent approximately 5% of intracranial aneurysms (Drake et al. [1968]). Visual impairment, which occurs in 16%-40% of patients, is among the most common presentations of these aneurysms (Day [1990], Lai and Morgan [2013], Sahlein et al. [2015], and Silva et al. [2017]). Flow-diverting stents, such as the Pipeline Embolization Device (PED), are increasingly used to treat these aneurysms, in part because of their theoretical reduction of mass effect (Fiorella et al. [2009]). Limited data on paraclinoid aneurysms treated with a PED exist, and few studies have compared outcomes of patients after PED placement with those of patients after clipping or coiling. METHODS The authors performed a retrospective analysis of 115 patients with an aneurysm of the cavernous to ophthalmic segments of the internal carotid artery treated with clipping, coiling, or PED deployment between January 2011 and March 2017. Postoperative complications were defined as new neurological deficit, aneurysm rupture, recanalization, or other any operative complication that required reintervention. RESULTS A total of 125 paraclinoid aneurysms in 115 patients were treated, including 70 with PED placement, 23 with coiling, and 32 with clipping. Eighteen (14%) aneurysms were ruptured. The mean aneurysm size was 8.2 mm, and the mean follow-up duration was 18.4 months. Most aneurysms were discovered incidentally, but visual impairment, which occurred in 21 (18%) patients, was the most common presenting symptom. Among these patients, 15 (71%) experienced improvement in their visual symptoms after treatment, including 14 (93%) of these 15 patients who were treated with PED deployment. Complete angiographic occlusion was achieved in 89% of the patients. Complications were seen in 17 (15%) patients, including 10 (16%) after PED placement, 2 (9%) after coiling, and 5 (17%) after clipping. Patients with incomplete aneurysm occlusion had a higher rate of procedural complications than those with complete occlusion (p = 0.02). The rate of postoperative visual improvement was significantly higher among patients treated with PED deployment than in those treated with coiling (p = 0.01). The significant predictors of procedural complications were incomplete occlusion (p = 0.03), hypertension, (p = 0.04), and diabetes (p = 0.03). CONCLUSIONS In a large series in which patient outcomes after treatment of paraclinoid aneurysms were compared, the authors found a high rate of aneurysm occlusion and a comparable rate of procedural complications among patients treated with PED placement compared with the rates among those who underwent clipping or coiling. For patients who presented with visual symptoms, those treated with PED placement had the highest rate of visual improvement. The results of this study suggest that the PED is an effective and safe modality for treating paraclinoid aneurysms, especially for patients who present with visual symptoms.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Comparison of flow diversion with clipping and coiling for the treatment of paraclinoid aneurysms in 115 patients

Silva

See

Khandelwal

et al. 2019

Journal of Neurosurgery

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“…2 Numerous studies have since demonstrated the safety and efficacy of the PED in treating aneurysms with varying morphologies in different anatomic locations. [3][4][5][6][7][8] As the clinical indications for PED placement expand, predictors of radiographic outcomes have become a topic of ongoing investigation. Although 1 study found that fusiform aneurysm morphology and shorter follow-up length were independent predictors of incomplete occlusion, this study was limited by a small sample size and a mean follow-up of 6.1 months.…”

mentioning

confidence: 99%

Predictors of Incomplete Occlusion following Pipeline Embolization of Intracranial Aneurysms: Is It Less Effective in Older Patients?

Adeeb

Moore

Wirtz

et al. 2017

AJNR Am J Neuroradiol

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Complete occlusion following PED treatment of intracranial aneurysms can be influenced by several factors related to the patient, aneurysm, and treatment. Of these factors, older age (older than 70 years) and nonsmoking status were independent predictors of incomplete occlusion. While the physiologic explanation for these findings remains unknown, identification of factors predictive of incomplete aneurysm occlusion following PED placement can assist in patient selection and counseling and might provide insight into the biologic factors affecting endothelialization.

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“…10 Numerous studies have since demonstrated the safety and efficacy of the PED in the treatment of aneurysms with varying morphologies and anatomic locations. [11][12][13][14][15][16] Currently, only a few studies with small numbers of patients have evaluated endovascular treatment of tandem aneurysms with coil embolization, 8 stentassisted coiling, 9 or flow diversion. 9 In this study, we compare the outcomes following deployment of a single PED in 2 groups of patients, those with solitary ICA aneurysms and those with tandem ICA aneurysms.…”

mentioning

confidence: 99%

Treatment of Tandem Internal Carotid Artery Aneurysms Using a Single Pipeline Embolization Device: Evaluation of Safety and Efficacy

Adeeb

Moore

Griessenauer

et al. 2017

AJNR Am J Neuroradiol

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Pipeline Embolization Device for Small Intracranial Aneurysms: Evaluation of Safety and Efficacy in a Multicenter Cohort

Abstract: In the largest series on PED for small aneurysms to date, data suggest that treatment with the flow-diverting PED is safe and efficacious, with complication rates comparable to those for traditional endovascular techniques.

Cited by 64 publications

References 31 publications

Comparison of flow diversion with clipping and coiling for the treatment of paraclinoid aneurysms in 115 patients

Comparison of flow diversion with clipping and coiling for the treatment of paraclinoid aneurysms in 115 patients

Predictors of Incomplete Occlusion following Pipeline Embolization of Intracranial Aneurysms: Is It Less Effective in Older Patients?

Treatment of Tandem Internal Carotid Artery Aneurysms Using a Single Pipeline Embolization Device: Evaluation of Safety and Efficacy

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