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

Nohra Chalouhi, Mario Zanaty, Alex Whiting, Steven Yang, Stavropoula Tjoumakaris, David Hasan, Robert M. Starke, Shannon Hann, Christine Hammer, David Kung, Robert Rosenwasser, Pascal Jabbour

Research output: Contribution to journalArticlepeer-review

87 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1498-1502
Number of pages5
JournalJournal of neurosurgery
Volume122
Issue number6
DOIs
StatePublished - Jun 2015
Externally publishedYes

Keywords

  • Flow diversion
  • Intracranial aneurysm
  • Pipeline Embolization Device
  • Small aneurysm
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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