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Original research
Postoperative occlusion degree after flow-diverter placement with adjunctive coiling: analysis of complications
  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. Ying Zhang1,
  17. Xinjian Yang1
  1. 1 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, China
  8. 8 First Affiliated Hospital of Xinjiang Medical University, Uruqi, China
  9. 9 Qilu Hospital of Shandong University, Jinan, China
  10. 10 Nanfang Hospital, Southern Medical University, Guangzhou, China
  11. 11 First Affiliated Hospital of Nanchang University, Nanchang, 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 Ying Zhang; yingzhang829{at}; Xinjian Yang; yangxinjian{at}


Background Although coiling with a flow diverter may provide immediate dome protection, no studies have evaluated the effect on complications of postoperative occlusion degree immediately postoperatively. The purpose of this study was to determine whether postoperative occlusion degree immediately after flow-diverter placement with adjunctive coiling was associated with complications.

Methods All patients’ data were collected from the post-market multi-center cohort study of embolization of intracranial aneurysms with a pipeline embolization device (PED) in China (PLUS) registry. We divided patients into those treated with a PED alone (PED-only (PO) group), those treated with a PED with coils and incomplete occlusion (PED + coils + incomplete occlusion (PCIO) group), and those treated with a PED with coils and complete occlusion (PED + coils + complete occlusion (PCCO) group).

Results We evaluated 1171 consecutive patients with 1322 aneurysms treated with a PED: 685 aneurysms were treated with PO, 444 with PCIO, and 193 with PCCO. The PCCO group had a higher rate of aneurysm occlusion at the last follow-up than the PCIO and PO groups (P<0.0001). Multivariate analysis of the predictors of ischemic stroke and modified Rankin Scale score (mRS) deterioration showed that PCCO was an independent predictor of ischemic stroke (HR, 2.03; 95% CI, 1.12 to 3.67; P=0.019) and mRS deterioration (HR, 2.59; 95% CI, 1.57 to 4.26; P<0.0001).

Conclusions Although postoperative complete occlusion with a PED and adjunctive coiling can increase the rate of aneurysm occlusion, this approach may also increase the risk of ischemic stroke and lead to poor postoperative functional outcomes.

  • aneurysm
  • flow diverter
  • coil
  • complication

Data availability statement

No data are available. N / A.

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Data availability statement

No data are available. N / A.

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  • Contributors Study conception: XJY and YZ; study design: XJY, HBK, and BL; data analysis: HBK; manuscript drafting: HBK, BL, YZ, and XJY; acquisition of data: the PLUS Study Group. All of the coauthors have approved the submitted version and agreed to publication.

  • Funding This study was sponsored by the National Key Research and Development Plan of China (grant number: 2016YFC1300800), the National Natural Science Foundation of China (grant numbers: 81220108007, 81801156, 81801158, 81471167, and 81671139), the Special Research Project for Capital Health Development (grant number: 2018-4-1077), 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.