In-Pipeline Stenosis: Incidence, Predictors, and Clinical Outcomes

Nohra Chalouhi, Adam Polifka, Badih Daou, David Kung, Guilherme Barros, Stavropula Tjoumakaris, L. Fernando Gonzalez, Robert M. Starke, David Hasan, Brendan Judy, Robert H. Rosenwasser, Pascal Jabbour

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Background: The Pipeline Embolization Device is a widely utilized flow diverter in the treatment of intracranial aneurysms. Objective: To assess the incidence, clinical significance, predictors, and outcomes of in-Pipeline stenosis (IPS). Methods: Angiographic studies in 139 patients treated between 2011 and 2013 were independently reviewed by 2 authors for the presence of IPS. Multivariable logistic regression analysis was conducted to determine predictors of IPS. Results: A total of 21 (15.8%) patients demonstrated some degree of IPS during the follow-up period at a mean time point of 6.7 months (range, 3-24 months). The stenosis was mild (<50%) in 11 patients, moderate (50%-75%) in 5, and severe (>75%) in 6. None were symptomatic or required further intervention. Sixteen of these 22 patients (73%) had IPS detected within 6 months. IPS was noted in 7.6% (1/13) of patients with posterior circulation aneurysms vs 16.7% (21/126) of those with anterior circulation aneurysms (P .03). The rate of IPS was 60% (3/5) in patients who did not receive aspirin vs only 14.2% (19/134) in those who received aspirin (P .02). In multivariable analysis, no aspirin therapy (odds ratio, 10.0; 95% confidence interval, 1.4-67.7; P .02) and internal carotid artery aneurysm location (odds ratio, 3.1; 95% confidence interval, 1.1-8.8; P .03) were strong independent predictors of IPS. Conclusion: IPS is a common, early, and mostly benign complication. Patients with internal carotid artery aneurysms are more likely to develop IPS. Aspirin plays a key role in preventing IPS. The results of this study further support the safety of flow diverters.

Original languageEnglish (US)
Pages (from-to)875-879
Number of pages5
JournalNeurosurgery
Volume77
Issue number6
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Keywords

  • Aneurysm
  • Pipeline Embolization Device
  • Stenosis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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