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Original research
Marked decrease in coil and stent utilization following introduction of flow diversion technology
  1. Emanuela Crobeddu1,
  2. Giuseppe Lanzino1,
  3. David F Kallmes2,
  4. Harry J Cloft2
  1. 1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Professor Giuseppe Lanzino, Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; lanzino.giuseppe{at}


Background Flow diversion represents a major paradigm shift in the treatment of unruptured intracranial aneurysms. The potential impact of this technique on coil utilization and adjunctive techniques such as balloon-assisted and stent-assisted coiling is unknown. In this study, the effect of introduction of flow diversion devices on the utilization of coil and adjunctive techniques was assessed.

Methods A retrospective review was conducted of consecutive patients with unruptured aneurysms treated at our institution comparing two groups: Group 1 (patients treated in the 2-year interval preceding the introduction of the Pipeline Embolization Device (PED) and Group 2 (patients treated during the 2-year interval following introduction in our practice of the PED).

Results Mean aneurysm diameter was 8.7±6.3 mm in Group 1 and 8.5±6.1 mm in Group 2 (p=0.79). PED therapy was employed in 38 (21.7%) of 175 aneurysms in Group 2. The proportion of stent-assisted procedures was significantly less in Group 2 than in Group 1 (6.9% vs 14.7%, p=0.04), as was the proportion of patients undergoing parent artery sacrifice (0.6% vs 3.9%, p=0.046). The mean and median number of coils used per aneurysm were 5.4±3.6 and 5 (range 1–18) for Group 1 and 3.2±3.2 and 3 (range 0–19) for Group 2 (p≤0.0001).

Conclusions Flow diversion represents a disruptive technology. More than one-fifth of unruptured aneurysms at our institution were treated with PED after introduction of this technology, resulting in marked decreases in coil and stent utilization.

  • Aneurysm

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  • Competing interests None.

  • Ethics approval The ethics approval was provided by Institutional Review Board.

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