Safety and efficacy of the Pipeline Embolization Device in 100 small intracranial aneurysms

Restricted access

OBJECT

Flow diverters are increasingly used for treatment of intracranial aneurysms. In most series, the Pipeline Embolization Device (PED) was used for the treatment of large, giant, complex, and fusiform aneurysms. Little is known about the use of the PED in small aneurysms. The purpose of this study was to assess the safety and efficacy of the PED in small aneurysms (≤ 7 mm).

METHODS

A total of 100 consecutive patients were treated with the PED at the authors' institution between May 2011 and September 2013. Data on procedural safety and efficacy were retrospectively collected.

RESULTS

The mean aneurysm size was 5.2 ± 1.5 mm. Seven patients (7%) had sustained a subarachnoid hemorrhage. All except 5 aneurysms (95%) arose from the anterior circulation. The number of PEDs used was 1.2 per aneurysm. Symptomatic procedure-related complications occurred in 3 patients (3%): 1 distal parenchymal hemorrhage that was managed conservatively and 2 ischemic events. At the latest follow-up (mean 6.3 months), 54 (72%) aneurysms were completely occluded (100%), 10 (13%) were nearly completely occluded (≥ 90%), and 11 (15%) were incompletely occluded (< 90%). Six aneurysms (8%) required further treatment. Increasing aneurysm size (OR 3.8, 95% CI 0.99–14; p = 0.05) predicted retreatment. All patients achieved a favorable outcome (modified Rankin Scale Score 0–2) at follow-up.

CONCLUSIONS

In this study, treatment of small aneurysms with the PED was associated with low complication rates and high aneurysm occlusion rates. These findings suggest that the PED is a safe and effective alternative to conventional endovascular techniques for small aneurysms. Randomized trials with long-term follow-up are necessary to determine the optimal treatment that leads to the highest rate of obliteration and the best clinical outcomes.

ABBREVIATIONSICA = internal carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; PED = Pipeline Embolization Device; SAH = subarachnoid hemorrhage.

Article Information

Correspondence Pascal M. Jabbour, Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut St., 3rd Fl., Philadelphia, PA 19107. email: pascal.jabbour@jefferson.edu.

INCLUDE WHEN CITING Published online January 30, 2015; DOI: 10.3171/2014.12.JNS14411.

DISCLOSURE Drs. Jabbour and Tjoumakaris are consultants for Covidien, and Dr. Tjoumakaris is also a consultant for Stryker.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Angiogram showing a small 5-mm aneurysm arising from the left ICA (A). A PED was inserted in the ICA (B), with complete occlusion at follow-up (C).

  • View in gallery

    Angiogram showing a 5-mm fusiform aneurysm arising from the M3 segment of the middle cerebral artery (MCA) (A and B). A PED was successfully placed across the aneurysm in the MCA (C). Follow-up angiogram showing 100% aneurysm occlusion, with remodeling of the parent vessel (D).

References

  • 1

    Becske TKallmes DFSaatci IMcDougall CGSzikora ILanzino G: Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology 267:8588682013

  • 2

    Chalouhi NDumont ASRandazzo CTjoumakaris SGonzalez LFRosenwasser R: Management of incidentally discovered intracranial vascular abnormalities. Neurosurg Focus 31:6E12011

  • 3

    Chalouhi NJabbour PSinghal SDrueding RStarke RMDalyai RT: Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke 44:134813532013

  • 4

    Chalouhi NSatti SRTjoumakaris SDumont ASGonzalez LFRosenwasser R: Delayed migration of a Pipeline Embolization Device. Neurosurgery 72:2 Suppl Operativeons229ons2342013

  • 5

    Chalouhi NTjoumakaris SStarke RMGonzalez LFRandazzo CHasan D: Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms. Stroke 44:215021542013

  • 6

    Chalouhi NTjoumakaris SIGonzalez LFHasan DPema PJGould G: Spontaneous delayed migration/shortening of the pipeline embolization device: report of 5 cases. AJNR Am J Neuroradiol 34:232623302013

  • 7

    D'Urso PILanzino GCloft HJKallmes DF: Flow diversion for intracranial aneurysms: a review. Stroke 42:236323682011

  • 8

    De Vries JBoogaarts JVan Norden AWakhloo AK: New generation of Flow Diverter (surpass) for unruptured intracranial aneurysms: a prospective single-center study in 37 patients. Stroke 44:156715772013

  • 9

    Deshmukh VHu YCMcDougall CGBarnwell SLAlbuquerque FFiorella D: Histopathological assessment of delayed ipsilateral parenchymal hemorrhages after the treatment of paraclinoid aneurysms with the Pipeline Embolization Device. Neurosurgery 71:E551E5522012

  • 10

    Morita AKirino THashi KAoki NFukuhara SHashimoto N: The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366:247424822012

  • 11

    Jabbour PChalouhi NTjoumakaris SGonzalez LFDumont ASRandazzo C: The Pipeline Embolization Device: learning curve and predictors of complications and aneurysm obliteration. Neurosurgery 73:1131202013

  • 12

    Jabbour PMChalouhi NRosenwasser RH: The Pipeline Embolization Device: what have we learned?. World Neurosurg 80:7987992013

  • 13

    Kallmes DFDing YHDai DKadirvel RLewis DACloft HJ: A new endoluminal, flow-disrupting device for treatment of saccular aneurysms. Stroke 38:234623522007

  • 14

    Kan PSiddiqui AHVeznedaroglu ELiebman KMBinning MJDumont TM: Early postmarket results after treatment of intracranial aneurysms with the pipeline embolization device: a U.S. multicenter experience. Neurosurgery 71:108010882012

  • 15

    Lin LMColby GPKim JEHuang JTamargo RJCoon AL: Immediate and follow-up results for 44 consecutive cases of small (<10 mm) internal carotid artery aneurysms treated with the pipeline embolization device. Surg Neurol Int 4:1142013

  • 16

    Piano MValvassori LQuilici LPero GBoccardi E: Mid-term and long-term follow-up of cerebral aneurysms treated with flow diverter devices: a single-center experience. J Neurosurg 118:4084162013

  • 17

    Pierot LWakhloo AK: Endovascular treatment of intracranial aneurysms: current status. Stroke 44:204620542013

  • 18

    Pistocchi SBlanc RBartolini BPiotin M: Flow diverters at and beyond the level of the circle of Willis for the treatment of intracranial aneurysms. Stroke 43:103210382012

  • 19

    Saatci IYavuz KOzer CGeyik SCekirge HS: Treatment of intracranial aneurysms using the Pipeline Flow-Diverter Embolization Device: a single-center experience with longterm follow-up results. AJNR Am J Neuroradiol 33:143614462012

  • 20

    Yu SCKwok CKCheng PWChan KYLau SSLui WM: Intracranial aneurysms: midterm outcome of Pipeline Embolization Device—a prospective study in 143 patients with 178 aneurysms. Radiology 265:8939012012

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 70 70 49
Full Text Views 354 354 6
PDF Downloads 222 222 8
EPUB Downloads 0 0 0

PubMed

Google Scholar