Background Flow diversion with the Pipeline embolization device is a well-established method of intracranial aneurysm treatment. However, deployment of the first-generation device (Pipeline Classic) can be technically challenging. The Pipeline Flex contains the same flow-diverting stent with a modified delivery system.
Objective To compare procedural outcomes between the first-generation device (Pipeline Classic) and the Pipeline Flex.
Methods Thirty-eight of the first 40 consecutive patients who underwent intracranial aneurysm treatment with the Pipeline Flex and 58 of the most recent 60 consecutive patients who underwent treatment with the Pipeline Classic at our institution were evaluated. Patient demographics, aneurysm characteristics, technical procedural details, and early outcomes were analyzed.
Results The two groups were comparable for age, gender, and location of target aneurysms. Use of Pipeline Flex decreased procedure time by 44.2 min (p≤0.001) and fluoroscopy time by 22.0 min (p=0.001) compared with the Pipeline Classic. Similarly, radiation exposure was less in the Flex group with a mean difference of 3473.5 Gy cm2 (p=0.002), while contrast usage was decreased with a mean difference of 22.3 mL (p=0.007). These differences remained significant in multivariate regression analysis. Finally, the rate of device deployment failure was lower in the Flex group (7.1%) than in the Classic group (23.9%) (p=0.034).
Conclusions Use of Pipeline Flex significantly reduces the total procedure and fluoroscopy time, contrast usage, patient radiation exposure, and proportion of recaptured devices in comparison with the Pipeline Classic, probably owing to an enhanced delivery system that allows for more reliable and controlled deployment.
- Flow Diverter
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Contributors EJL contributed to the project design, monitored data collection and maintained the database, contributed to the statistical analysis plan, organized and analyzed the data, and drafted and revised the paper. TM initiated the project, contributed to the project design, monitored data collection and maintained the database, contributed to the statistical analysis plan, organized and analyzed the data, and drafted and revised the paper. YS contributed to the statistical analysis plan, organized and analyzed the data, and revised the paper. RS contributed to the collection of data and revised the paper. GJ contributed clinical data and revised the paper. DG contributed to the project design, provided clinical data, and revised the paper.
Competing interests None declared.
Ethics approval University of Maryland, Baltimore institutional review board.
Provenance and peer review Not commissioned; externally peer reviewed.