Background Flow diversion is a common endovascular treatment for cerebral aneurysms, but studies comparing different types of flow diverters are scarce.
Objective To perform a propensity score matched cohort study comparing the Pipeline Embolization Device (PED) and Flow Redirection Intraluminal Device (FRED) for posterior circulation aneurysms.
Methods Consecutive aneurysms of the posterior circulation treated at 25 neurovascular centers with either PED or FRED were collected. Propensity score matching was used to control for age, duration of follow-up imaging, adjunctive coiling, and aneurysm location, size, and morphology; previously ruptured aneurysms were excluded. The two devices were compared for the following outcomes: procedural complications, aneurysm occlusion, and functional outcome.
Results A total of 375 aneurysms of the posterior circulation were treated in 369 patients. The PED was used in 285 (77.2%) and FRED in 84 (22.8%) procedures. Aneurysms treated with the PED were more commonly fusiform and larger than those treated with FRED. To account for these important differences, propensity score matching was performed resulting in 33 PED and FRED unruptured aneurysm pairs. No differences were found in occlusion status and neurologic thromboembolic or hemorrhagic complications between the two devices. The proportion of patients with favorable functional outcome was higher with FRED (100% vs 87.9%, p=0.04).
Conclusion Comparative analysis of PED and FRED for the treatment of unruptured posterior circulation aneurysms did not identify significant differences in aneurysm occlusion or neurologic complications. Variations in functional outcomes warrant additional investigations.
- flow diverter
- posterior fossa
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Contributorship Statement All authors included on a paper fulfill all four criteria of authorship, including substantial contributions to the conception or design of the work, the acquisition, analysis, and interpretation of data for the work, drafting the work or revising it critically for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Conception and design: CJG, AE-M, AAD. Acquisition of data: all authors. Analysis and interpretation of data: CJG, AE-M, AAD. Drafting the article: CJG. Critical revision of the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: CJG. Statistical analysis: CJG, AE-M. Administrative/technical/material support: all authors. Study supervision: CJG, AE-M, AAD.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests Ajith Thomas: DSMB SCENT trial by STRYKER. Funds paid to institution.
Ramesh Grandhi: Consultant for Medtronic neurovascular, BALT neurovascular and Cerenovus.
Christoph Griessenauer: Consultant for Stryker and received research funding from Medtronic.
Naci Kocer: Consultant and proctoring agreement with MicroVention.
Philipp Taussky:Reply: Consultant for Medtronic, Stryker, Cerenovus.
Peter Kan: Consultant for Stryker, Medtronic, MicroVention, and Cerenovus.
Vincent Tutino: Co-founder of Neurovascular Diagnostics, Inc.
Monika Killer: Research grant from MicroVention/Terumo.
Waleed Brinjikji: Microvention and Cerenovus consultant.
Tom Marotta: Medtronic proctoring.
Timo Krings: Consultant for Stryker, Medtronic, Penumbra, Cerenovus. stockholder in Marblehead Inc, royalties from Thieme.
Clemens Schirmer: Research Support from Penumbra. Shareholder in Neurotechnology Investors.
Giuseppe Lanzino: Consultant for Superior Medical Editing and Nested Knowledge.
Christian Ulfert: Consulting fees from Johnson & Johnson.
Charles Matouk: Consultant for Medtronic, Penumbra, Silk Road Medical
Markus Mohlenbruch: Consultant for Medtronic, MicroVention, Stryker. Grants/grants pending: Balt (money paid to the institution), MicroVention (money paid to the institution). Payment for lectures includings service on speakers bureaus: Medtronic, MicroVention, and Stryker.
Marshall Cress: Consulting for Cannon and Cerenovus.
None related to this study and none are declared for the reminder of the authors.
Patient consent for publication Not required.
Ethics Approval The study was performed in compliance with the World Medical Association’s Declaration of Helsinki. The study protocol was approved by the local ethics committees of Erlanger, Hamburg, Heidelberg, Istanbul, Linz, Nurnberg, Salzburg, Homburg, Sunnybrook, Beth Israel Deaconess, Geisinger, Toronto Western, St. Michael’s, Yale, Buffalo, Florence, University of Alabama, Firoozgar, Baylor, Brigham and Women’s, Mayo Clinic, University of Utah, Orlando Health, Massachusetts General and Xuanwu.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request and after execution of required necessary data use agreements.