Pipeline embolization of cerebral aneurysms in pediatric patients: combined systematic review of patient-level data and multicenter retrospective review

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  • 1 Departments of Neurological Surgery and
  • 2 Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago;
  • 3 Division of Neurosurgery and
  • 4 Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois; and
  • 5 Departments of Radiology and Neurological Surgery, New York University Grossman School of Medicine, Bernard and Irene Schwartz Neurointerventional Radiology Section, NYU Langone Medical Center, New York, New York
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OBJECTIVE

Cerebral aneurysms in the pediatric population are rare and optimal treatment strategies are not as well characterized as in adults. The Pipeline embolization device (PED) is an endoluminal flow diverter that is commonly used to treat aneurysms in adults, but experience with this device in children is limited. The authors sought to further characterize PED use and outcomes in this specific population by performing both a systematic review of patient-level data from studies reporting the use of the PED to treat pediatric aneurysms and a retrospective review of their experience.

METHODS

A systematic review of the PubMed, Embase, and Scopus databases was performed to identify studies reporting the use of the PED in pediatric patients (age ≤ 18 years). Disaggregated data regarding demographics, aneurysm characteristics, treatment, and outcomes were collected. Retrospective data from the authors’ two institutions were also included.

RESULTS

Thirty studies comprising patient-level data on 43 pediatric patients with 47 aneurysms were identified. An additional 9 patients with 9 aneurysms were included from the authors' institutions for a total of 52 patients with 56 aneurysms. The mean patient age was 11.1 years. Presentations included aneurysm rupture (17.3%) and symptomatic mass effect (23.1%). Aneurysms were located in the anterior circulation in 55.4% of cases, and 73.2% were described as nonsaccular. Imaging follow-up was available for 89.3% with a mean follow-up of 13.3 months. Aneurysm occlusion was reported in 75%, with 1 case each (1.8%) demonstrating significant in-stent stenosis and parent vessel occlusion. Clinical follow-up was reported in 90.4% with a mean follow-up of 14.7 months. Good functional outcomes (modified Rankin Scale score of 0–1 or Glasgow Outcome Scale score of 5) were reported in 65.4% of the total population. Two major complications were reported, including 1 death.

CONCLUSIONS

Despite substantial differences in aneurysm location and type between published pediatric and adult patient populations treated with the PED, the use of the PED in the pediatric population appears to be safe. While the short-term effectiveness is also similar to that of adults, additional studies are needed to further characterize the long-term outcomes and better define the use of this device in pediatric patients.

ABBREVIATIONS ASPIRe = Aneurysm Study of Pipeline in an Observational Registry; GOS = Glasgow Outcome Scale; ICA = internal carotid artery; IntrePED = International Retrospective Study of the Pipeline Embolization Device; MCA = middle cerebral artery; mRS = modified Rankin Scale; PED = Pipeline embolization device; PRISMA = Preferred Reporting Items for Systematic Review and Meta-Analyses; PUFS = Pipeline for Uncoilable or Failed Aneurysms; VBJ = vertebrobasilar junction.

Supplementary Materials

    • Supplementary Table 1 (PDF 623 KB)

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Contributor Notes

Correspondence Matthew B. Potts: Feinberg School of Medicine, Northwestern University, Chicago, IL. matthew.potts@northwestern.edu.

INCLUDE WHEN CITING Published online April 23, 2021; DOI: 10.3171/2020.10.PEDS20324.

Disclosures Dr. Shapiro and Dr. Riina report being consultants to Medtronic.

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