Background Flow diversion of intracranial aneurysms with the Pipeline Embolization Device (PED) is commonly performed, but the value of long-term angiographic follow-up has not been rigorously evaluated. Here we examine the prevalence of actionable findings of aneurysm recurrence and development of in-stent stenosis in a cohort of patients that underwent long-term angiographic follow-up at multiple time points.
Methods Angiographic data from eligible patients were retrospectively assessed for aneurysm occlusion, in-stent stenosis, and aneurysm regrowth or recurrence. Patients were included in this study if they underwent angiographic imaging at 6 months post-treatment and at least one later time point.
Results 100% (132/132) of aneurysms occluded at 6 months remained occluded at final follow-up. 85.7% (6/7), 56.3% (27/48), and 25% (6/24) of aneurysms with entry remnant, subtotal filling, and total filling, respectively, at 6 months were completely occluded at final follow-up. 98.7% (147/149) of PED constructs that demonstrated no stenosis at 6 months demonstrated no stenosis at final angiography, while 44.4% (8/18) of PED constructs demonstrating in-stent stenosis at 6 months had resolution of stenosis on final angiography.
Conclusions Among patients who undergo treatment of intracranial aneurysms with PED, the value of long-term angiography in patients demonstrating complete aneurysm occlusion and no in-stent stenosis on 6 month post-treatment angiography is low.
- flow diverter
Data availability statement
Data are available upon reasonable request.
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Contributors All authors have met ICMJE criteria for authorship, and all authors have read and approved the submitted manuscript. Study conception: DCL and APK. Data collection: DCL, SJC. Data analysis: DCL, SJC, and APK. Manuscript writing: DCL and APK. Critical revision: SJC, APK, ARC, JWO, CJM, APK. Final approval: SJC, APK, ARC, JWO, CJM, APK.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests JWO is a consultant for Medtronic and Microvention. CJM is a consultant for Medtronic and Cerenovus. APK is a consultant for Penumbra, Microvention, and iSchemaView, and is on the iSchemaView medical advisory board.
Provenance and peer review Not commissioned; externally peer reviewed.
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