Multiple pipeline embolization devices improves aneurysm occlusion without increasing morbidity: A single center experience of 140 cases |
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| Institution: | 1. Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China;2. Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China;1. Departments of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;2. Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;3. Pathology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;4. Department of General Internal Medicine, JCHO Sendai Hospital, Sendai, Miyagi, Japan;1. Neurosurgery Department. Hospital Universitario y Politécnico La Fe, Valencia, Spain;2. Pathology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain;3. Brain Tumour Laboratory, Fundación Vithas, Grupo Hospitales Vithas, Madrid, Spain;4. Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain;5. Nanomedicine and Sensors Unit, Hospital Universitario y Politécnico La Fe, Universidad Politécnica de Valencia, Spain;1. Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States;2. Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States |
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| Abstract: | IntroductionRates of aneurysm occlusion with the pipeline embolization device (PED) has varied widely in the literature from 55.7% to 93.3% at 6 months, which may reflect a difference in technique including sizing and number of devices used.Methods140 cases at our institution were retrospectively reviewed, and aneurysms treated with a single PED vs. multiple were compared.ResultsComplete aneurysm occlusion was achieved in 86.9% at 6 months, 91.8% at 1 year, and 97.6% at longest follow-up. Retreatment with an additional device was required in 7 (5.1%). Major and minor complication rate within 30 days was 1.4% and 5.0%, and at greater than 30 days was 0.8% and 3.1%.Patients treated with multiple PEDs had significantly higher rates of aneurysm occlusion at 6 months (92.9% vs. 75.6%, p = 0.017) and 12 months (98.4% vs. 81.1%, p = 0.014), with no difference in complications. The two groups were similar aside from a higher number of ophthalmic and paraophthalmic aneurysms treated with multiple PEDs (23.4% vs. 6.5%, p = 0.004; and 35.1% vs. 17.4%, p = 0.020), and more posterior communicating artery and recurrent aneurysms treated with a single PED (28.3% vs. 3.2%, p = 0.001; 23.9% vs. 8.5%, p = 0.031). The use of multiple PEDs was found to be an independent predictor of aneurysm occlusion in a multivariate analysis (p = 0.015).ConclusionsThe use of multiple PEDs for intracranial aneurysms leads to significantly higher occlusion rates without added morbidity. This benefit is particularly appropriate for ophthalmic segment aneurysms, while more distal segments with eloquent perforating branches should be managed with caution. |
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| Keywords: | Aneurysm occlusion Pipeline embolization device (PED) Intracranial aneurysms |
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