D F Kallmes1, R Hanel2, D Lopes3, E Boccardi4, A Bonafé5, S Cekirge6, D Fiorella7, P Jabbour8, E Levy9, C McDougall10, A Siddiqui9, I Szikora11, H Woo7, F Albuquerque10, H Bozorgchami12, S R Dashti13, J E Delgado Almandoz14, M E Kelly15, R Turner16, B K Woodward17, W Brinjikji18, G Lanzino18, P Lylyk19. 1. From the Department of Radiology (D.F.K., W.B., G.L.), Mayo Clinic, Rochester, Minnesota Kallmes.david@mayo.edu. 2. Department of Neurosurgery (R.H.), Mayo Clinic, Jacksonville, Florida. 3. Department of Neurological Surgery (D.L.), Rush University Medical Center, Chicago, Illinois. 4. Department of Neuroradiology (E.B.), Niguarda CA' Granda Hospital, Milan, Italy. 5. Department of Neuroradiology (A.B.), Hôpital Gui de Chauliac, Montpellier, France. 6. Department of Radiology (S.C.), Hacettepe University Hospitals, Ankara, Turkey. 7. Department of Neurological Surgery (D.F., H.W.), Stony Brook University Medical Center, Stony Brook, New York. 8. Department of Neurosurgery (P.J.), Thomas Jefferson University, Philadelphia, Pennsylvania. 9. Department of Neurosurgery (E.L., A.S.), University at Buffalo, State University of New York, Buffalo, New York. 10. Department of Neurosurgery (C.M., F.A.), Barrow Neurological Associates, Phoenix, Arizona. 11. National Institute of Neurosciences (I.S.), Budapest, Hungary. 12. Department of Neurology (H.B.), Oregon Health and Science University, Portland, Oregon. 13. Norton Neuroscience Institute (S.R.D.), Louisville, Kentucky. 14. Department of Radiology (J.E.D.A.), Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota. 15. Division of Neurosurgery, Department of Surgery (M.E.K.), University of Saskatchewan, Saskatoon, Saskatchewan, Canada. 16. Department of Neurosciences (R.T.), Medical University of South Carolina, Charleston, South Carolina. 17. Vista Radiology PC (B.K.W.), Knoxville, Tennessee. 18. From the Department of Radiology (D.F.K., W.B., G.L.), Mayo Clinic, Rochester, Minnesota. 19. Department of Neuroscience (P.L.), Equipo de Neurocirugía Endovascular Radiología Intervencionista, Buenos Aires, Argentina.
Abstract
BACKGROUND AND PURPOSE: Flow diverters are increasingly used in the endovascular treatment of intracranial aneurysms. Our aim was to determine neurologic complication rates following Pipeline Embolization Device placement for intracranial aneurysm treatment in a real-world setting. MATERIALS AND METHODS: We retrospectively evaluated all patients with intracranial aneurysms treated with the Pipeline Embolization Device between July 2008 and February 2013 in 17 centers worldwide. We defined 4 subgroups: internal carotid artery aneurysms of ≥10 mm, ICA aneurysms of <10 mm, other anterior circulation aneurysms, and posterior circulation aneurysms. Neurologic complications included spontaneous rupture, intracranial hemorrhage, ischemic stroke, permanent cranial neuropathy, and mortality. Comparisons were made with t tests or ANOVAs for continuous variables and the Pearson χ(2) or Fisher exact test for categoric variables. RESULTS: In total, 793 patients with 906 aneurysms were included. The neurologic morbidity and mortality rate was 8.4% (67/793), highest in the posterior circulation group (16.4%, 9/55) and lowest in the ICA <10-mm group (4.8%, 14/294) (P = .01). The spontaneous rupture rate was 0.6% (5/793). The intracranial hemorrhage rate was 2.4% (19/793). Ischemic stroke rates were 4.7% (37/793), highest in patients with posterior circulation aneurysms (7.3%, 4/55) and lowest in the ICA <10-mm group (2.7%, 8/294) (P = .16). Neurologic mortality was 3.8% (30/793), highest in the posterior circulation group (10.9%, 6/55) and lowest in the anterior circulation ICA <10-mm group (1.4%, 4/294) (P < .01). CONCLUSIONS: Aneurysm treatment with the Pipeline Embolization Device is associated with the lowest complication rates when used to treat small ICA aneurysms. Procedure-related morbidity and mortality are higher in the treatment of posterior circulation and giant aneurysms.
BACKGROUND AND PURPOSE: Flow diverters are increasingly used in the endovascular treatment of intracranial aneurysms. Our aim was to determine neurologic complication rates following Pipeline Embolization Device placement for intracranial aneurysm treatment in a real-world setting. MATERIALS AND METHODS: We retrospectively evaluated all patients with intracranial aneurysms treated with the Pipeline Embolization Device between July 2008 and February 2013 in 17 centers worldwide. We defined 4 subgroups: internal carotid artery aneurysms of ≥10 mm, ICA aneurysms of <10 mm, other anterior circulation aneurysms, and posterior circulation aneurysms. Neurologic complications included spontaneous rupture, intracranial hemorrhage, ischemic stroke, permanent cranial neuropathy, and mortality. Comparisons were made with t tests or ANOVAs for continuous variables and the Pearson χ(2) or Fisher exact test for categoric variables. RESULTS: In total, 793 patients with 906 aneurysms were included. The neurologic morbidity and mortality rate was 8.4% (67/793), highest in the posterior circulation group (16.4%, 9/55) and lowest in the ICA <10-mm group (4.8%, 14/294) (P = .01). The spontaneous rupture rate was 0.6% (5/793). The intracranial hemorrhage rate was 2.4% (19/793). Ischemic stroke rates were 4.7% (37/793), highest in patients with posterior circulation aneurysms (7.3%, 4/55) and lowest in the ICA <10-mm group (2.7%, 8/294) (P = .16). Neurologic mortality was 3.8% (30/793), highest in the posterior circulation group (10.9%, 6/55) and lowest in the anterior circulation ICA <10-mm group (1.4%, 4/294) (P < .01). CONCLUSIONS:Aneurysm treatment with the Pipeline Embolization Device is associated with the lowest complication rates when used to treat small ICA aneurysms. Procedure-related morbidity and mortality are higher in the treatment of posterior circulation and giant aneurysms.
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