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  • Pipeline embolization device versus Atlas stent assisted coiling for intracranial aneurysm treatment: a retrospective, propensity score matched study with a focus on midterm outcomes and hospital costs

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Hemorrhagic stroke
Original research
Pipeline embolization device versus Atlas stent assisted coiling for intracranial aneurysm treatment: a retrospective, propensity score matched study with a focus on midterm outcomes and hospital costs
  1. Chao Wang1,2,
  2. Linggen Dong1,2,
  3. Jian Liu1,2,
  4. Yisen Zhang1,2,
  5. Kun Wang1,2,
  6. Peng Liu1,2,
  7. Xinjian Yang1,2,
  8. Ming Lv1,2,
  9. Ying Zhang1,2
  1. 1 Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
  2. 2 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Ying Zhang, Department of Interventional Neuroradiology and Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; yingzhang829{at}163.com; Dr Ming Lv, Department of Interventional Neuroradiology and Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; dragontiger{at}163.com

Abstract

Background Stent assisted coiling (SAC) and flow diverters (FDs) are common endovascular treatments for wide necked cerebral aneurysms, but studies comparing the new generation Atlas SAC and FDs are scarce. We performed a propensity score matched (PSM) cohort study to compare the Atlas SAC and the pipeline embolization device (PED) for proximal internal carotid artery (ICA) aneurysms.

Methods Consecutive ICA aneurysms treated at our institution with either the Atlas SAC or PED were studied. PSM was used to control for age, sex, smoking, hypertension, and hyperlipidemia, and the rupture status, maximal diameter, and neck size of the aneurysm (aneurysms >15 mm and non-saccular aneurysms were excluded). Midterm outcomes and hospital costs were compared between these two devices.

Results A total of 309 patients with 316 ICA aneurysms were included. Following PSM, 178 aneurysms treated with the Atlas SAC and PED were matched (n=89 in each group). Aneurysms treated with the Atlas SAC required a slightly longer procedure time, but had lower hospital costs than those treated with the PED (115.2±24.6 vs 102.4±40.8 min, P=0.012; $27 650.2±$6961.4 vs $34 107.0±$3707.2, P<0.001). Atlas SAC and PED treatments showed equivalent aneurysm occlusion rates (89.9% vs 86.5%, P=0.486), complication rates (5.6% vs 11.2%, P=0.177), and a favorable functional outcome (96.6% vs 97.8%, P=1.0) at follow-up (8.2±3.0 vs 8.4±4.2 months, P=0.652).

Conclusion In this PSM study, midterm outcomes of the PED and Atlas SAC in the treatment of ICA aneurysms were similar. However, SAC required a longer operation time, and the PED may increase the economic cost of inpatients in Beijing, China.

  • Aneurysm
  • Intervention
  • Flow Diverter

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-020173

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @Yes, @Ying Zhang

    • CW and LD contributed equally.

    • ML and YZ contributed equally.

    • Contributors YingZ and ML contributed to the study conception and design. The first draft of the manuscript was written by CW and LD. Material preparation and data collection were performed by JL, YisenZ, KW, PL, and XY. Data analysis was performed by CW, LD, YingZ, and ML. YingZ and ML are guarantors for the paper. All authors read and approved the final manuscript.

    • Funding This study was supported by the National Natural Science Foundation of China (grant Nos 82072036, 82272092,82271319), Capital's Funds for Research (grant No 2022-1-2041), and Summit Talent Program (grant No DFL 20220504).

    • Competing interests None declared.

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