BACKGROUND: Flow diversion represents a major paradigm shift in the treatment of unruptured intracranial aneurysms. The potential impact of this technique on coil utilization and adjunctive techniques such as balloon-assisted and stent-assisted coiling is unknown. In this study, the effect of introduction of flow diversion devices on the utilization of coil and adjunctive techniques was assessed. METHODS: A retrospective review was conducted of consecutive patients with unruptured aneurysms treated at our institution comparing two groups: Group 1 (patients treated in the 2-year interval preceding the introduction of the Pipeline Embolization Device (PED) and Group 2 (patients treated during the 2-year interval following introduction in our practice of the PED). RESULTS: Mean aneurysm diameter was 8.7 ± 6.3 mm in Group 1 and 8.5 ± 6.1 mm in Group 2 (p=0.79). PED therapy was employed in 38 (21.7%) of 175 aneurysms in Group 2. The proportion of stent-assisted procedures was significantly less in Group 2 than in Group 1 (6.9% vs 14.7%, p=0.04), as was the proportion of patients undergoing parent artery sacrifice (0.6% vs 3.9%, p=0.046). The mean and median number of coils used per aneurysm were 5.4 ± 3.6 and 5 (range 1-18) for Group 1 and 3.2 ± 3.2 and 3 (range 0-19) for Group 2 (p ≤ 0.0001). CONCLUSIONS: Flow diversion represents a disruptive technology. More than one-fifth of unruptured aneurysms at our institution were treated with PED after introduction of this technology, resulting in marked decreases in coil and stent utilization.
BACKGROUND: Flow diversion represents a major paradigm shift in the treatment of unruptured intracranial aneurysms. The potential impact of this technique on coil utilization and adjunctive techniques such as balloon-assisted and stent-assisted coiling is unknown. In this study, the effect of introduction of flow diversion devices on the utilization of coil and adjunctive techniques was assessed. METHODS: A retrospective review was conducted of consecutive patients with unruptured aneurysms treated at our institution comparing two groups: Group 1 (patients treated in the 2-year interval preceding the introduction of the Pipeline Embolization Device (PED) and Group 2 (patients treated during the 2-year interval following introduction in our practice of the PED). RESULTS: Mean aneurysm diameter was 8.7 ± 6.3 mm in Group 1 and 8.5 ± 6.1 mm in Group 2 (p=0.79). PED therapy was employed in 38 (21.7%) of 175 aneurysms in Group 2. The proportion of stent-assisted procedures was significantly less in Group 2 than in Group 1 (6.9% vs 14.7%, p=0.04), as was the proportion of patients undergoing parent artery sacrifice (0.6% vs 3.9%, p=0.046). The mean and median number of coils used per aneurysm were 5.4 ± 3.6 and 5 (range 1-18) for Group 1 and 3.2 ± 3.2 and 3 (range 0-19) for Group 2 (p ≤ 0.0001). CONCLUSIONS: Flow diversion represents a disruptive technology. More than one-fifth of unruptured aneurysms at our institution were treated with PED after introduction of this technology, resulting in marked decreases in coil and stent utilization.
Authors: N Chalouhi; S Tjoumakaris; J L H Phillips; R M Starke; D Hasan; C Wu; M Zanaty; D Kung; L F Gonzalez; R Rosenwasser; P Jabbour Journal: AJNR Am J Neuroradiol Date: 2014-04-30 Impact factor: 3.825
Authors: T E Darsaut; J-C Gentric; C M McDougall; G Gevry; D Roy; A Weill; J Raymond Journal: AJNR Am J Neuroradiol Date: 2015-01-15 Impact factor: 3.825
Authors: Jessica K Campos; Barry Cheaney Ii; Brian V Lien; David A Zarrin; Chau D Vo; Geoffrey P Colby; Li-Mei Lin; Alexander L Coon Journal: Stroke Vasc Neurol Date: 2020-03-25