Introduction Flow-diverting stents have revolutionized the endovascular treatment of intracranial aneurysms. The purpose of this study is to identify predictors of adverse outcomes associated with the pipeline embolization device (PED).
Materials and methods A retrospective analysis was performed of all patients treated with PED at a single high-volume center from January 2014 to September of 2018. Clinical outcomes, neurological morbidity/mortality and additional variables were analyzed.
Results 204 aneurysms in 170 patients were treated with PED. Mean length of follow up was 11 months. 181 aneurysms (89%) were located in the anterior circulation, 23 (11%) were found in the posterior circulation. The majority of the aneurysms were saccular (82%), followed by fusiform (11%), blister (4%) and dissecting pseudoaneurysms (3%). Mean aneurysm size was 8.2 + 5.7 mm with 145 (71%) small aneurysms (< 10 mm), 53 (26%) large aneurysms (10–24 mm), and 6 (3%) giant aneurysms (≥25 mm). 92% of aneurysms were unruptured, 8% were ruptured. Neurological symptoms lasting less than 7 days were considered minor. The overall major neurological morbidity/mortality was 4.7% and 1.8% respectively. The all-cause mortality was 2.9%. After Bonferroni correction for multiple testing (significance at 0.004 level), the only significant predictors of neurological morbidity/mortality included the baseline modified Rankin Scale (mRS; p=0.001) and aneurysm neck size (p=0.003). Aneurysm size (p=0.006), rupture at presentation (0.006) anterior versus posterior location (p=0.02) did not reach significance for multiple testing. The Platelet Reactivity Unit (PRU), parent vessel diameter and patient age were not associated with adverse events.
Conclusions The PED has a satisfactory safety profile in experienced hands, both on- and off-label. Nevertheless, a poor clinical baseline and a wider neck independently predict an increased risk of neurological morbidity/mortality.
Disclosures A. Griffin: None. E. Hauck: None.
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