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Hemorrhagic stroke
Original research
Mortality after treatment of intracranial aneurysms with the Pipeline Embolization Device
  1. Huibin Kang1,
  2. Bin Luo1,
  3. Jianmin Liu2,
  4. Hongqi Zhang3,
  5. Tianxiao Li4,
  6. Donglei Song5,
  7. Yuanli Zhao6,
  8. Sheng Guan7,
  9. Aisha Maimaitili8,
  10. Yunyan Wang9,
  11. Wenfeng Feng10,
  12. Yang Wang11,
  13. Jieqing Wan12,
  14. Guohua Mao13,
  15. Huaizhang Shi14,
  16. Kun Wang1,
  17. Xinjian Yang1
  1. 1 Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2 Changhai Hospital Affiliated to Naval Medical University, Shanghai, China
  3. 3 Xuanwu Hospital, Capital Medical University, Beijing, China
  4. 4 Zhengzhou University People′s Hospital, Zhengzhou, China
  5. 5 Shanghai Donglei Brain Hospital, Shanghai, China
  6. 6 Peking University International Hospital, Beijing, China
  7. 7 First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
  8. 8 First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
  9. 9 Qilu Hospital of Shandong University, Jinan, China
  10. 10 Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
  11. 11 First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
  12. 12 Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  13. 13 Second Affiliated Hospital of Nanchang University, Nanchang, China
  14. 14 First Affiliated Hospital of Harbin Medical University, Harbin, China
  1. Correspondence to Dr Xinjian Yang, Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100050, Beijing, China; yangxinjian{at}voiceoftiantan.org; Dr Kun Wang, Department of Interventional Neuroradiology, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, 100050, Beijing, China; wangkun650{at}126.com

Abstract

Background The Pipeline Embolization Device (PED) is reported to be a safe treatment tool for aneurysms. However, mortality occurs in a few cases, and this has not been clearly studied. We conducted a multicenter study to retrospectively evaluate the causes of, and risk factors for, mortality in patients with intracranial aneurysms treated with the PED.

Methods We retrospectively reviewed the prospectively maintained databases of patients with intracranial aneurysms treated by PED placement at 14 academic institutions from 2014 to 2019. Patients’ data, including clinical and radiographic information, were analyzed with an emphasis on mortality-related complications.

Results A total of 1171 consecutive patients underwent 1319 PED procedures to treat 1322 intracranial aneurysms. The mortality rate was 1.5% (17/1171), and in 1.3% of the patients (15/1171), deaths were caused by delayed aneurysmal rupture, distal intraparenchymal hemorrhage, and neurological compression symptoms associated with PED procedures. Multivariate analysis showed that previous treatment (OR, 12.657; 95% CI, 3.189 to 50.227; P<0.0001), aneurysm size ≥10 mm (OR, 4.704; 95% CI, 1.297 to 17.068; P=0.019), aneurysm location (basilar artery) (OR, 10.734; 95% CI, 2.730 to 42.207; P=0.001), and current subarachnoid hemorrhage (OR, 4.505; 95% CI, 0.991 to 20.474; P=0.051) were associated with neurological complications resulting in mortality.

Conclusions Delayed aneurysm rupture, distal intraparenchymal hemorrhage, and neurological compression were the main causes of mortality in patients with intracranial aneurysms treated with the PED. Large basilar aneurysms are associated with an increased risk of postoperative death and require increased attention and caution.

  • aneurysm
  • complication
  • stroke
  • flow diverter

Data availability statement

No data are available. N/A.

https://doi.org/10.1136/neurintsurg-2020-017002

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    Data availability statement

    No data are available. N/A.

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    Footnotes

    • Contributors All authors have made substantial contributions to the design of the work, or the acquisition, analysis, or interpretation of the data; drafting the work or revising it critically for important intellectual content; final approval of the version 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.

    • Funding This work was supported by the National Key Research and Development Plan of China (grant number: 2016YFC1300800), the National Natural Science Foundation of China (grant number: 81671139), and Medtronic, Inc.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.