Introduction/Purpose Pipeline embolization devices (PEDs) are increasingly used in treatment of cerebral aneurysms. Yet, risk factors associated with major ischemic or hemorrhagic complications after PED treatment are not well-established. We performed a meta-analysis to investigate risk factors associated with major intracranial complications following PED treatment. We also aimed to examine whether platelet function testing is associated with lower risk of these complications.

Materials and methods We searched PubMed database to identify reports on the treatment of cerebral aneurysms using PEDs between 2009 and 2017, with data available on major ischemic/hemorrhagic complications, or platelet function testing before intervention. Random-effect models were used to pool data on determinants of ischemic or hemorrhagic complications across studies.

Results A total of 14 studies were included in this analysis, including 2388 patients with available data on platelet function testing. The mean follow-up interval was 6.4 months. Variables associated with higher odds of ischemic or hemorrhagic complications included male sex (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.01–3.17), hypertension (2.54, 1.44–4.49) and concurrent aneurysm treatment (4.08, 1.63–10.18). Anterior location and size <10 mm of the aneurysm were associated with 58% and 63% lower risk of major complications (0.42, 0.20–0.89; and 0.37, 0.23–0.60, respectively). Use of multiple PEDs did not significantly increase the risk of complications (2.35, 0.54–10.21). A total of 1701 patients underwent platelet function testing, while 687 patients did not undergo platelet function testing. There was no significant difference in symptomatic hemorrhagic or thrombotic complications between PED patients without vs. with platelet function testing (1.58, 0.26–9.52 vs 1.33, 0.83–2.16, respectively).

Conclusion In this pooled analysis, we reported the main factors associated with major intracranial complications in patients undergoing PED placement. Platelet function testing was not associated with decreased major complications in these patients. Future prospective studies are required to identify subgroups with highest risk of major complications after treatment with PEDs.

Disclosures H. Saber: None. P. Chamiraju: None. S. Narayanan: None.