The second-generation Pipeline embolization device (PED), Flex, has several design upgrades, including improved opening and the ability to be resheathed, in comparison with the original device (PED classic). The authors hypothesized that Flex is associated with a lower rate of major complications.
A prospective, IRB-approved, single-institution database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion. The PED classic was used from August 2011 to January 2015, and the Pipeline Flex has been used since February 2015.
A total of 568 PED procedures (252 classic and 316 Flex) were performed for anterior circulation aneurysms. The average aneurysm size was 6.8 mm. Patients undergoing treatment with the Flex device had smaller aneurysms (p = 0.006) and were more likely to have undergone previous treatments (p = 0.001). Most aneurysms originated along the internal carotid artery (89% classic and 75% Flex) but there were more anterior cerebral artery (18%) and middle cerebral artery (7%) deployments with Flex (p = 0.001). Procedural success was achieved in 96% of classic and 98% of Flex cases (p = 0.078). Major morbidity or death occurred in 3.5% of cases overall: 5.6% of classic cases, and 1.9% of Flex cases (p = 0.019). On multivariate logistic regression, predictors of major complications were in situ thrombosis (OR 4.3, p = 0.006), classic as opposed to Flex device (OR 3.7, p = 0.008), and device deployment in the anterior cerebral artery or middle cerebral artery as opposed to the internal carotid artery (OR 3.5, p = 0.034).
Flow diversion of anterior circulation cerebral aneurysms is associated with an overall low rate of major complications. The complication rate is significantly lower since the introduction of the second-generation PED (Flex).
ABBREVIATIONSACA = anterior cerebral artery; Cat5 = AXS Catalyst 5; ICA = internal carotid artery; ICH = intracranial hemorrhage; IntrePED = International Retrospective Study of the Pipeline Embolization Device; MCA = middle cerebral artery; PED = Pipeline embolization device; PRU = P2Y12 reaction units; PUFS = Pipeline for Uncoilable or Failed Aneurysms; SAH = subarachnoid hemorrhage; TIA = transient ischemic attack.
Correspondence Alexander Coon: Johns Hopkins Medicine, Baltimore, MD. email@example.com.INCLUDE WHEN CITING Published online January 12, 2018; DOI: 10.3171/2017.7.JNS171289.
Drs. Colby and Bender share first authorship of this work.
Disclosures Dr. Colby: consultant for MicroVention; and research support from and participant in clinical trials for Medtronic and Stryker. Dr. Lin: consultant for Medtronic Neurovascular; and receives research support from MicroVention and Stryker. Dr. Huang: ownership in Longeviti. Dr. Coon: consultant and proctor for Stryker Neurovascular, Medtronic, and MicroVention.
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