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Hemorrhagic stroke
Original research
Comparison of a covered stent and pipeline embolization device in intracranial aneurysm: a propensity score matching analysis
  1. Xin Tong1,
  2. Xiaopeng Xue1,
  3. Mingjiang Sun1,
  4. Mingyang Han2,
  5. Peng Jiang1,
  6. Aihua Liu1
  1. 1Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, China
  1. Correspondence to Dr Aihua Liu, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; liuaihuadoctor{at}163.com; Peng Jiang, Beijing Neurosurgical Institute, Beijing Tiantan Hospital,Capital Medical University, Beijing, China; Jiangpeng33{at}126.com

Abstract

Background The Willis covered stent (WCS) and pipeline embolization device (PED) have partly overlapping therapeutic indications. However, the differences of effect between these two treatments remain unclear.

Objective To compare clinical outcome, angiographic outcome, and complications following treatment with a WCS versus PED.

Methods Patients with intracranial aneurysms treated by a WCS or PED between January 2015 and December 2020 were included. The primary outcomes were complications, clinical outcome (modified Rankin Scale score >2), and angiographic outcome (incomplete aneurysm occlusion). Propensity score matching was conducted to adjust for potential confounding factors.

Results A total of 94 aneurysms treated by WCS and 698 aneurysms by PED were included. Compared with the PED group, patients in the WCS group are younger, a greater number have a poor condition at admission, a larger proportion of ruptured, non-saccular, and anterior circulation aneurysms, a smaller aneurysm neck width, and less coiling assistance is required. A total of 42 (44.7%) branches were covered by WCS. After adjustment for age, sex, aneurysm type, rupture status, neck size, aneurysm location, and coiling, 50 WCS and PED pairs were examined for internal carotid artery aneurysms. No significant differences were observed in clinical (10.4% vs 2.1%, P=0.206) and angiographic outcomes (12.8% vs 18.2%, P=0.713). However, 27 branches covered by WCS, including 22 ophthalmic arteries and five posterior communicating arteries. Patients in the WCS group had a higher intraoperative complication rate than those in the PED group (28% vs 6%, P=0.008), especially in the occlusion rate of covered branches (51.9% vs 11.1%, P<0.001).

Conclusion The comparable clinical and angiographic outcomes of WCS or PED demonstrate the therapeutic potential of WCS as a viable alternative for aneurysms. However, the complication of occlusion of covered branches might not be negligible.

  • Flow Diverter
  • Intervention
  • Aneurysm

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-020878

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • XT and XX contributed equally.

    • Contributors All authors contributed to the paper, satisfying the ICMJE guidelines for authorship. XT: study design, data interpretation, statistical analysis, and critical revision of the manuscript. XX: data collection, data analysis, data interpretation, and manuscript drafting. MS and MH: data collection and critical revision of the manuscript. PJ and AL: study design, study supervision, and critical revision of the manuscript. AL: the author responsible for the overall content as guarantor. All authors gave approval of the submitted version and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding Natural Science Foundation of China (81771233, 82171290). Research and Promotion Program of Appropriate Techniques for Intervention of Chinese High-risk Stroke People (GN-2020R0007). Beijing Municipal Administration of Hospitals' Ascent Plan (DFL20190501). Beijing Natural Science Foundation (7222050, L192013). Beijing Municipal Science & Technology Commission Administrative Commission of Zhongguancun Science Park (20220484167).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.