Matthew James Kole1, Timothy Ryan Miller2, Gregory Cannarsa1, Aaron Wessell1, Salazar Jones1, Elizabeth Le1, Gaurav Jindal2, François Aldrich1, J Marc Simard1, Dheeraj Gandhi2.
Abstract
OBJECTIVE: Flow diversion using the Pipeline embolization device (PED) has become a widely used treatment method for intracranial aneurysms. However, a subset of aneurysms will fail to occlude following treatment and the factors that influence the efficacy of flow diversion remain uncertain. As smaller diameter PEDs inherently have greater metal density than larger devices, we elected to investigate whether PED diameter influences treatment efficacy when using a single device. We also evaluated other factors that may influence treatment outcomes with PED.
METHODS: We retrospectively evaluated all patients treated for an intracranial saccular aneurysm at our institution with a single PED at least 12 months prior to the time of data collection. Patients treated with multiple devices, adjunctive coiling, traumatic and fusiform target aneurysms, as well as patients with inadequate imaging follow-up (<12 months) were excluded.
RESULTS: 158 aneurysms in 124 patients (128 treatments) met the inclusion criteria for our study. 123 aneurysms (80%) were occluded over an average follow-up of 26.6 months. Multivariable logistic regression showed that branch vessel incorporation into the target aneurysm sac (p<0.001, OR=0.15) was significantly associated with aneurysm persistence, while smaller PED diameter was significantly associated with aneurysm occlusion (p=0.008; OR=0.30).
CONCLUSIONS: PED diameter significantly impacts outcomes when using a single device for the treatment of small anterior circulation intracranial saccular aneurysms, most likely due to the inherent greater metal density of smaller devices. This factor should be taken into account when planning endovascular aneurysm treatment with PED. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
OBJECTIVE: Flow diversion using the Pipeline embolization device (PED) has become a widely used treatment method for intracranial aneurysms. However, a subset of aneurysms will fail to occlude following treatment and the factors that influence the efficacy of flow diversion remain uncertain. As smaller diameter PEDs inherently have greater metal density than larger devices, we elected to investigate whether PED diameter influences treatment efficacy when using a single device. We also evaluated other factors that may influence treatment outcomes with PED.
METHODS: We retrospectively evaluated all patients treated for an intracranial saccular aneurysm at our institution with a single PED at least 12 months prior to the time of data collection. Patients treated with multiple devices, adjunctive coiling, traumatic and fusiform target aneurysms, as well as patients with inadequate imaging follow-up (<12 months) were excluded.
RESULTS: 158 aneurysms in 124 patients (128 treatments) met the inclusion criteria for our study. 123 aneurysms (80%) were occluded over an average follow-up of 26.6 months. Multivariable logistic regression showed that branch vessel incorporation into the target aneurysm sac (p<0.001, OR=0.15) was significantly associated with aneurysm persistence, while smaller PED diameter was significantly associated with aneurysm occlusion (p=0.008; OR=0.30).
CONCLUSIONS: PED diameter significantly impacts outcomes when using a single device for the treatment of small anterior circulation intracranial saccular aneurysms, most likely due to the inherent greater metal density of smaller devices. This factor should be taken into account when planning endovascular aneurysm treatment with PED. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Entities:
Keywords:
cerebral aneurysm; flow diverter
Year: 2019
PMID： 30926687 DOI： 10.1136/neurintsurg-2019-014792
Source DB: PubMed Journal: J Neurointerv Surg ISSN： 1759-8478 Impact factor: 5.836