Christoph J Griessenauer1,2, Ajith J Thomas3, Alejandro Enriquez-Marulanda3, Aviraj Deshmukh2, Abhi Jain1,4, Christopher S Ogilvy3, Naci Kocer5, Tobias Engelhorn6, Markus Möhlenbruch7, Markus Holtmannspötter8, Hendrik Janssen9, Thomas Finkenzeller10, Wolfgang Reith11, Michael Sonnberger12, Jan-Hendrik Buhk13, Clemens M Schirmer1, Monika Killer-Oberpfalzer14. 1. Department of Neurosurgery, Geisinger, Danville, Pennsylvania. 2. Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria. 3. Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. 4. Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. 5. Department of Neuroradiology, Cerrahpasa Medical School, Istanbul University, Turkey. 6. Department of Neuroradiology, University Hospital Erlangen, Germany. 7. Department of Neuroradiology, Universitätsklinikum Heidelberg, Germany. 8. Department of Diagnostic Radiology, Section for Neuroradiology, Rigshospitalet, Copenhagen, Denmark. 9. Institute for Neuroradiology, Klinikum Ingolstadt, Germany. 10. Institute of Radiology and Neuroradiology, Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Germany. 11. Clinic for Diagnostic and Interventional Neuroradiology, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. 12. Department of Neuroradiology, Kepler Universitätsklinikum Linz, Austria. 13. Department of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany. 14. Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
Abstract
BACKGROUND: Flow diversion has become an accepted endovascular treatment modality for intracranial aneurysms. Studies comparing different types of flow diverters are currently lacking. OBJECTIVE: To perform a propensity score-matched cohort study comparing the Pipeline Embolization Device (PED; Medtronic, Dublin, Ireland) and Flow Redirection Endoluminal Device (FRED; MicroVention, Aliso Viejo, California). METHODS: Aneurysms of the internal carotid artery proximal to the communicating segment treated with PED at 2 neurovascular centers in the United States were matched with aneurysms treated in the European FRED study using propensity scoring. Aneurysms treated in the setting of subarachnoid hemorrhage were excluded from matching. Occlusion rates and complications were evaluated. RESULTS: Two hundred twenty-one internal carotid artery aneurysms were treated with PED and 282 with FRED. Propensity score matching controlling for age, sex, aneurysm size, location, number of flow diverters, and adjunctive coiling resulted in 55 matched pairs. Median angiographic follow-up was nonsignificantly longer for FRED compared to PED (12.2 vs 7.5 mo, P = .28). The rate of complete occlusion did not differ between flow diverters (80% vs 80%, P > .99). Functional outcome and complications were comparable for PED and FRED. CONCLUSION: Propensity score-matched analysis of PED and FRED for internal carotid artery aneurysms revealed comparable angiographic complete occlusion and complication rates. Whether FRED has an advantage in terms of near complete aneurysm occlusion warrants further investigation. Limitations include the retrospective design and lack of an independent assessment of radiographic outcome in a core-laboratory and functional outcomes, among others, and the results should be interpreted as such.
BACKGROUND: Flow diversion has become an accepted endovascular treatment modality for intracranial aneurysms. Studies comparing different types of flow diverters are currently lacking. OBJECTIVE: To perform a propensity score-matched cohort study comparing the Pipeline Embolization Device (PED; Medtronic, Dublin, Ireland) and Flow Redirection Endoluminal Device (FRED; MicroVention, Aliso Viejo, California). METHODS:Aneurysms of the internal carotid artery proximal to the communicating segment treated with PED at 2 neurovascular centers in the United States were matched with aneurysms treated in the European FRED study using propensity scoring. Aneurysms treated in the setting of subarachnoid hemorrhage were excluded from matching. Occlusion rates and complications were evaluated. RESULTS: Two hundred twenty-one internal carotid artery aneurysms were treated with PED and 282 with FRED. Propensity score matching controlling for age, sex, aneurysm size, location, number of flow diverters, and adjunctive coiling resulted in 55 matched pairs. Median angiographic follow-up was nonsignificantly longer for FRED compared to PED (12.2 vs 7.5 mo, P = .28). The rate of complete occlusion did not differ between flow diverters (80% vs 80%, P > .99). Functional outcome and complications were comparable for PED and FRED. CONCLUSION: Propensity score-matched analysis of PED and FRED for internal carotid artery aneurysms revealed comparable angiographic complete occlusion and complication rates. Whether FRED has an advantage in terms of near complete aneurysm occlusion warrants further investigation. Limitations include the retrospective design and lack of an independent assessment of radiographic outcome in a core-laboratory and functional outcomes, among others, and the results should be interpreted as such.
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