TY - JOUR T1 - Long-term outcomes and dynamic changes of in-stent stenosis after Pipeline embolization device treatment of intracranial aneurysms JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg DO - 10.1136/jnis-2022-019680 SP - jnis-2022-019680 AU - Siming Gui AU - Xiheng Chen AU - Dachao Wei AU - Dingwei Deng AU - Wei You AU - Xiangyu Meng AU - Jian Lv AU - Junqiang Feng AU - Yudi Tang AU - Shu Yang AU - Ting Chen AU - Peng Liu AU - Huijian Ge AU - Hengwei Jin AU - Xinke Liu AU - Yuhua Jiang AU - Wei Feng AU - Youxiang LI Y1 - 2023/01/23 UR - http://jnis.bmj.com/content/early/2023/01/22/jnis-2022-019680.abstract N2 - Background Flow diverters have revolutionized the treatment of intracranial aneurysms. However, the delayed complications associated with flow diverter use are unknown.Objective To evaluate the incidence, severity, clinical outcomes, risk factors, and dynamic changes associated with in-stent stenosis (ISS) after treatment with a Pipeline embolization device (PED).Methods Patients who underwent PED treatment between 2015 and 2020 were enrolled. The angiographic, clinical, and follow-up data of 459 patients were independently reviewed by four neuroradiologists to identify ISS. Binary logistic regression was conducted to determine ISS risk factors, and an ISS–time curve was established to demonstrate dynamic changes in ISS after PED implantation.Results Of the 459 treated patients, 69 (15.0%) developed ISS. At follow-up, nine patients (2.0%) with ISS demonstrated reversal, while 18 (3.9%) developed parental artery occlusion. A total of 380 patients (82.8%) achieved complete aneurysm occlusion (O’Kelly–Marotta grade D). Patients with posterior-circulation aneurysm (OR=2.895, 95% CI (1.732 to 4.838; P<0.001) or balloon angioplasty (OR=1.992, 95% CI 1.162 to 3.414; P=0.037) were more likely to develop ISS. Patients aged >54 years (OR=0.464, 95% CI 0.274 to 0.785; P=0.006) or with a body mass index of >28 kg/m2 (OR=0.427, 95% CI 0.184 to 0.991; P=0.026) had a lower ISS risk. Intimal hyperplasia initiated by PED placement peaked within 1 year after the procedure, rarely progressed after 12 months, and tended to reverse within 24 months.Conclusions ISS is a common, benign, and self-limiting complication of PED implantation in the Chinese population.Data are available upon reasonable request. The authors agree to share data upon reasonable request. Any data from this study are available by contacting the corresponding author. ER -