N Adeeb1,2, J M Moore1, M Wirtz1, C J Griessenauer1, P M Foreman3, H Shallwani4, R Gupta1, A A Dmytriw1, R Motiei-Langroudi1, A Alturki1, M R Harrigan3, A H Siddiqui4, E I Levy4, A J Thomas1, C S Ogilvy5. 1. From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. 2. Department of Neurosurgery (N.A.), Louisiana State University, Shreveport, Louisiana. 3. Department of Neurosurgery (P.M.F., M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama. 4. Department of Neurosurgery (H.S., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York. 5. From the Neurosurgical Service (N.A., J.M.M., M.W., C.J.G., R.G., A.A.D., R.M.-L., A.A., A.J.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts cogilvy@bidmc.harvard.edu.
Abstract
BACKGROUND AND PURPOSE: Flow diversion with the Pipeline Embolization Device (PED) for the treatment of intracranial aneurysms is associated with a high rate of aneurysm occlusion. However, clinical and radiographic predictors of incomplete aneurysm occlusion are poorly defined. In this study, predictors of incomplete occlusion at last angiographic follow-up after PED treatment were assessed. MATERIALS AND METHODS: A retrospective analysis of consecutive aneurysms treated with the PED between 2009 and 2016, at 3 academic institutions in the United States, was performed. Cases with angiographic follow-up were selected to evaluate factors predictive of incomplete aneurysm occlusion at last follow-up. RESULTS: We identified 465 aneurysms treated with the PED; 380 (81.7%) aneurysms (329 procedures; median age, 58 years; female/male ratio, 4.8:1) had angiographic follow-up, and were included. Complete occlusion (100%) was achieved in 78.2% of aneurysms. Near-complete (90%-99%) and partial (<90%) occlusion were collectively achieved in 21.8% of aneurysms and defined as incomplete occlusion. Of aneurysms followed for at least 12 months (211 of 380), complete occlusion was achieved in 83.9%. Older age (older than 70 years), nonsmoking status, aneurysm location within the posterior communicating artery or posterior circulation, greater aneurysm maximal diameter (≥21 mm), and shorter follow-up time (<12 months) were significantly associated with incomplete aneurysm occlusion at last angiographic follow-up on univariable analysis. However, on multivariable logistic regression, only age, smoking status, and duration of follow-up were independently associated with occlusion status. CONCLUSIONS: 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.
BACKGROUND AND PURPOSE: Flow diversion with the Pipeline Embolization Device (PED) for the treatment of intracranial aneurysms is associated with a high rate of aneurysm occlusion. However, clinical and radiographic predictors of incomplete aneurysm occlusion are poorly defined. In this study, predictors of incomplete occlusion at last angiographic follow-up after PED treatment were assessed. MATERIALS AND METHODS: A retrospective analysis of consecutive aneurysms treated with the PED between 2009 and 2016, at 3 academic institutions in the United States, was performed. Cases with angiographic follow-up were selected to evaluate factors predictive of incomplete aneurysm occlusion at last follow-up. RESULTS: We identified 465 aneurysms treated with the PED; 380 (81.7%) aneurysms (329 procedures; median age, 58 years; female/male ratio, 4.8:1) had angiographic follow-up, and were included. Complete occlusion (100%) was achieved in 78.2% of aneurysms. Near-complete (90%-99%) and partial (<90%) occlusion were collectively achieved in 21.8% of aneurysms and defined as incomplete occlusion. Of aneurysms followed for at least 12 months (211 of 380), complete occlusion was achieved in 83.9%. Older age (older than 70 years), nonsmoking status, aneurysm location within the posterior communicating artery or posterior circulation, greater aneurysm maximal diameter (≥21 mm), and shorter follow-up time (<12 months) were significantly associated with incomplete aneurysm occlusion at last angiographic follow-up on univariable analysis. However, on multivariable logistic regression, only age, smoking status, and duration of follow-up were independently associated with occlusion status. CONCLUSIONS: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.
Authors: A Rouchaud; C Johnson; E Thielen; D Schroeder; Y-H Ding; D Dai; W Brinjikji; J Cebral; D F Kallmes; R Kadirvel Journal: AJNR Am J Neuroradiol Date: 2015-12-31 Impact factor: 3.825
Authors: Ning Lin; Adam M Brouillard; Kiffon M Keigher; Demetrius K Lopes; Mandy J Binning; Kenneth M Liebman; Erol Veznedaroglu; Jordan A Magarik; J Mocco; Edward A Duckworth; Adam S Arthur; Andrew J Ringer; Kenneth V Snyder; Elad I Levy; Adnan H Siddiqui Journal: J Neurointerv Surg Date: 2014-09-17 Impact factor: 5.836
Authors: Juan P Salazar Adum; Luis Diaz Quintero; Harry E Fuentes; Benjamin B Lind; Joseph A Caprini; Alfonso J Tafur Journal: Int Angiol Date: 2017-05-24 Impact factor: 2.789
Authors: Ahmed E Hussein; Meghana Shownkeen; Andre Thomas; Christopher Stapleton; Denise Brunozzi; Jessica Nelson; John Naumgart; Andreas Linninger; Gursant Atwal; Ali Alaraj Journal: Interv Neuroradiol Date: 2020-02-26 Impact factor: 1.610
Authors: T P Madaelil; J A Grossberg; B M Howard; C M Cawley; J Dion; R G Nogueira; D C Haussen; F C Tong Journal: AJNR Am J Neuroradiol Date: 2019-03-07 Impact factor: 3.825
Authors: Anna Luisa Kühn; Peter Kan; Nils Henninger; Visish Srinivasan; Katyucia de Macedo Rodrigues; Ajay K Wakhloo; Matthew J Gounis; Ajit S Puri Journal: J Clin Neurosci Date: 2019-05-06 Impact factor: 1.961
Authors: Michael C Barbour; Fanette Chassagne; Venkat K Chivukula; Nathanael Machicoane; Louis J Kim; Michael R Levitt; Alberto Aliseda Journal: J Fluid Mech Date: 2021-03-31 Impact factor: 3.627
Authors: C J Griessenauer; M A Möhlenbruch; P Hendrix; C Ulfert; C Islak; M Sonnberger; T Engelhorn; E Müller-Thies-Broussalis; T Finkenzeller; M Holtmannspötter; J-H Buhk; W Reith; A Simgen; H Janssen; N Kocer; M Killer-Oberpfalzer Journal: AJNR Am J Neuroradiol Date: 2020-02-27 Impact factor: 3.825
Authors: T Sunohara; H Imamura; M Goto; R Fukumitsu; S Matsumoto; N Fukui; Y Oomura; T Akiyama; T Fukuda; K Go; S Kajiura; M Shigeyasu; K Asakura; R Horii; C Sakai; N Sakai Journal: AJNR Am J Neuroradiol Date: 2020-11-12 Impact factor: 3.825
Authors: Timothy G White; Brendan Ryu; Kevin A Shah; Justin Turpin; Karen Black; Thomas Link; Amir R Dehdashti; Jeffrey M Katz; Henry H Woo Journal: Interv Neuroradiol Date: 2021-06-20 Impact factor: 1.764
Authors: Benjamin Csippa; Dániel Gyürki; Gábor Závodszky; István Szikora; György Paál Journal: Cardiovasc Eng Technol Date: 2019-12-03 Impact factor: 2.495