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Hemorrhagic stroke
Original research
Treatment of fusiform aneurysms with a pipeline embolization device: a multicenter cohort study
  1. Mirzat Turhon1,2,
  2. Huibin Kang1,2,
  3. Mengxing Li1,2,
  4. Jian Liu1,2,
  5. Yisen Zhang1,2,
  6. Ying Zhang1,2,
  7. Jiliang Huang1,2,
  8. Bin Luo1,2,3,
  9. Jianmin Liu4,
  10. Hongqi Zhang5,
  11. Tianxiao Li6,
  12. Donglei Song7,
  13. Yuanli Zhao3,
  14. Sheng Guan8,
  15. Axir Aximujiang9,
  16. Aisha Maimaitili9,
  17. Yunyan Wang10,
  18. Wenfeng Feng11,
  19. Yang Wang12,13,
  20. Jieqing Wan14,
  21. Guohua Mao15,
  22. Huaizhang Shi16,
  23. Xiaolong Zhang17,
  24. Yuxiang Gu17,
  25. Xinjian Yang1,2
  1. 1 Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China
  2. 2 Department of Interventional Neuroradiology, Beijing TianTan Hospital, Capital Medical University, Beijing, People's Republic of China
  3. 3 Department of Neurosurgery, Peking University International Hospital, Beijing, People's Republic of China
  4. 4 Department of Neurosurgery, Changhai Hospital, Shanghai, Shanghai, People's Republic of China
  5. 5 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
  6. 6 Department of Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, Henan, People's Republic of China
  7. 7 Department of Neurosurgery, Shanghai Donglei Brain Hospital, Shanghai, People's Republic of China
  8. 8 Department of Intervention Neuroradiology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, People's Republic of China
  9. 9 Department of Neurosurgery, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, People's Republic of China
  10. 10 Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
  11. 11 Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
  12. 12 Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
  13. 13 Department of Neurosurgery, Beijing ChaoYang Hospital, Capital Medical University, Beijing, People's Republic of China
  14. 14 Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, Shanghai, People's Republic of China
  15. 15 Department of Neurosurgery, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, People's Republic of China
  16. 16 Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
  17. 17 Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, Shanghai, People's Republic of China
  1. Correspondence to Dr Xinjian Yang, Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing 100050, China; yangxinjian{at}voiceoftiantan.org; Dr Yuxiang Gu, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China; guyuxiang1972{at}126.com

Abstract

Background Intracranial fusiform aneurysms are less common than saccular aneurysms, but are associated with higher mortality and morbidity. We conducted this study to determine the safety and efficacy of the pipeline embolization device (PED) to treat intracranial fusiform aneurysms.

Methods This was a multicenter, retrospective, and observational study. Data for this study came from the PLUS study conducted from 2014 to 2019 across 14 centers in China. Univariate and multivariable logistic regression analyses were performed to evaluate predictors of the occlusion rate and complication.

Results A total of 1171 consecutive patients with 1322 intracranial aneurysms participated in this study. Among the participants, 104 patients with 109 fusiform aneurysms were eligible for this analysis (mean age 49 years, 36.5% women, aneurysm mean size 14.7 mm, 55% in the posterior circulation, and 6% in the basilar artery). Mean follow-up time was 9.0 months (range 3–36 months). The last DSA angiographic follow-up was available for 85 patients, and 58 aneurysms (68.2%) were completely occluded. The overall complication rate and mortality were 17.3% and 2.8%, respectively. Multivariate analysis demonstrated that age (OR=1.007, p=0.037) and cerebral atherosclerosis (OR=1.441, p=0.002) were associated with incomplete occlusion of fusiform aneurysms after PED treatment.

Conclusion PEDs may be an effective treatment for intracranial fusiform aneurysms, with a favorable occlusion rate. However, because these treatments have a relatively high rate of complications, PED treatment for fusiform aneurysms should be carefully and strictly controlled. Our analysis showed that PEDs with adjunctive coiling did not significantly improve the occlusion rate of fusiform aneurysms.

  • Aneurysm
  • Flow Diverter

Data availability statement

Data are available upon reasonable request. Not applicable.

https://doi.org/10.1136/neurintsurg-2021-018539

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    Data availability statement

    Data are available upon reasonable request. Not applicable.

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    Footnotes

    • MT and HK are joint first authors.

    • Twitter @Ying Zhang

    • Contributors All authors 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 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. Responsible for the overall content: Xinjian Yang and Yuxiang Gu.

    • Funding This study was sponsored by the National Natural Science Foundation of China (grant Nos: 82072036, 81801156, and 81801158), the Special Research Project for Capital Health Development (grant No: 2018-4-1077), and Research Projects of National Health Commission Capacity Building and Continuing Education Center in 2021 (grant No: GWJJ2021100103).

    • 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.