Introduction The Pipeline Embolization Device (PED) is commonly used to treat intracranial aneurysms. From its initial use, the indications expanded significantly to treating fusiform, blister, and dissecting intracranial aneurysms in the anterior and posterior circulation. Still, the treatment of saccular aneurysms continues to be controversial due to the ample variety of management modalities, from endovascular to microsurgical. This study analyzes the long-term occlusion rate and complications in saccular aneurysms treated with PED.

Methods We performed a systematic literature review and meta-analysis of studies of any design, including a minimum of 10 patients treated with PED for saccular aneurysms with at least 12 months follow-up. The primary effectiveness endpoint was the complete aneurysm occlusion rate. The primary safety endpoint was the rate of clinical complications measured by the cumulative symptomatic stroke (confirmed clinically and radiographically), intracranial hemorrhage, and aneurysmal rupture.

Results Our analysis comprised 11 studies, including 594 patients with 726 aneurysms. Most aneurysms were unruptured (72%, N=427) and small (77.4%). The mean age was 55.74 years, and most patients were women (78.3%; N= 465). One device was used in 580 aneurysms, and coils were added in 21. Previously treated aneurysms were 5.8%. Most aneurysms were small (89.75%; N= 1,340 aneurysms). The long-term complete occlusion rate was 81% (95%, CI 72% to 88%, p<0.01). The long-term symptomatic thromboembolic complication rate was 1% (95%, CI 0% to 4%, p=0.07). The rupture rate was 1% (95%, CI 0% to 3%, p=0.02), and the rate of intracranial hemorrhage was 3% (95%, CI 1% to 6%, p=0.81).

Conclusion The PED is a safe and effective method to treat intracranial saccular aneurysms: The long-term complete occlusion rate is high (81%), with almost a quarter of the patients persist with residual filling. Even longer follow-ups are expected to show higher occlusion rates.

Disclosures A. Ghaith: None. J. Rios-Zermeno: None. E. Greco: None. M. Bydon: None. R. Tawk: None.