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Hemorrhagic stroke
Original research
Spontaneous delayed migration or shortening after pipeline embolization device treatment of intracranial aneurysm: incidence, management, and risk factors
  1. Linggen Dong1,2,
  2. Chao Wang1,2,
  3. Dachao Wei1,2,
  4. Qichen Peng1,2,
  5. Xinzhi Wu2,
  6. Xiheng Chen3,
  7. Mingtao Li3,
  8. Tong Li3,
  9. He Liu3,
  10. Yang Zhao4,
  11. Ran Duan4,
  12. Weitao Jin4,
  13. Yukun Zhang4,
  14. Yang Wang3,
  15. Ming Lv1,2
  1. 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
  2. 2Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  3. 3Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
  4. 4Department of Neurosurgery, Peking University International Hospital, Beijing, China
  1. Correspondence to Dr Ming Lv, Interventional Neuroradiology, Beijing Tiantan Hospital Department of Interventional Neuroradiology, Beijing, Beijing, China; dragontiger{at}163.com; Dr Yang Wang, Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; 15110299052{at}163.com

Abstract

Background Studies reporting spontaneous delayed migration or shortening (SDMS) after treatment with the Pipeline Embolization Device (PED) are limited. This study aimed to evaluate the incidence of SDMS after PED treatment, propose management strategies, and identify the risk factors contributing to its occurrence.

Methods We retrospectively reviewed consecutive patients with an intracranial aneurysm (IA) treated with PEDs at three institutions. SDMS was classified as type I or II based on whether the PED covered the aneurysm neck.

Results The total cohort comprised 790 patients. SDMS was identified in 24 (3.04%) patients. Eighteen of the 24 patients had type I SDMS and did not require retreatment, while the remaining six patients had type II SDMS and all received retreatment. Multivariate logistic regression showed that the difference between the proximal and distal parent artery diameters (DPAD) (adjusted OR 2.977; 95% CI 1.054 to 8.405; P=0.039) and device tortuosity index (DTI) (adjusted OR 8.059; 95% CI 2.867 to 23.428; P<0.001) were independent predictors of SDMS after PED treatment, while the difference in length (DL) (adjusted OR 0.841; 95% CI 0.738 to 0.958; P=0.009) and PED plus coiling (adjusted OR 0.288; 95% CI 0.106 to 0.785; P=0.015) were protective factors.

Conclusion The incidence of SDMS after PED treatment of IA was 3.04%. For patients with type I SDMS with incomplete aneurysm occlusion we recommend continuous imaging follow-up while, for patients with type II SDMS, we recommend aggressive retreatment. The DPAD and DTI were independent risk predictors of SDMS after PED treatment, while the DL and PED plus coiling were protective factors.

  • Aneurysm
  • Flow Diverter
  • Complication

Data availability statement

Data are available upon reasonable request. Not applicable.

https://doi.org/10.1136/jnis-2024-021535

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    Data availability statement

    Data are available upon reasonable request. Not applicable.

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    Footnotes

    • LD and CW contributed equally.

    • Contributors ML and YW contributed to the study conception and design. The first draft of the manuscript was written by LD and CW. Material preparation and data collection were performed by DW, QP, XW, XC, ML, TL, HL, YZ, RD, WJ and YZ. Data analysis was performed by LD, CW, ML and YW. ML and YW are guarantors for the paper. All authors read and approved the final manuscript.

    • Funding This study was supported by the National Natural Science Foundation of China (grant number: 82271319).

    • 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.