TY - JOUR
T1 - Experience with the pipeline embolization device for posterior circulations aneurysms
T2 - A multicenter cohort study
AU - Griessenauer, Christoph J.
AU - Enriquez-Marulanda, Alejandro
AU - Taussky, Philipp
AU - Biswas, Arundhati
AU - Grandhi, Ramesh
AU - Xiang, Sissi
AU - Hong, Tao
AU - Rinaldo, Lorenzo
AU - Lanzino, Giuseppe
AU - Brinjikji, Waleed
AU - Burkhardt, Jan Karl
AU - Kan, Peter
AU - Ghuman, Mandeep
AU - Yang, Victor X.D.
AU - Chen, Karen
AU - Aziz-Sultan, Mohammad A.
AU - Ghorbani, Mohammad
AU - Schirmer, Clemens M.
AU - Goren, Oded
AU - Dalal, Shamsher S.
AU - Killer-Oberpfalzer, Monika
AU - Müller-Thies-Broussalis, Erasmia
AU - Koch, Matthew J.
AU - Stapleton, Christopher J.
AU - Patel, Aman B.
AU - Foreman, Paul M.
AU - Cress, Marshall C.
AU - Hirschl, Robert A.
AU - Krings, Timo
AU - Zhang, Hongqi
AU - Dmytriw, Adam A.
N1 - Publisher Copyright:
© 2020 by the Congress of Neurological Surgeons
PY - 2020/12/1
Y1 - 2020/12/1
N2 - BACKGROUND: The Pipeline Embolization Device (PED; Medtronic) has been used off-label for the treatment of challenging posterior circulation aneurysms. Data on this modality are primarily limited to small retrospective single-center series. OBJECTIVE: To assess safety and efficacy of this treatment by establishing an international, multicenter collaboration. METHODS: Consecutive posterior circulation aneurysms treated with the PED from 2012 to 2019 across 11 neurovascular centers were retrospectively reviewed. Baseline demographics, aneurysm and treatment characteristics, complications, occlusion status, and functional outcome were assessed. RESULTS: There were 149 posterior circulation aneurysms treated with PED in 146 patients. A total of 24 (16.4%) patients presented with subarachnoid hemorrhage. Most aneurysms were dissecting/blister (36.2%) in morphology, followed by saccular (35.6%) and fusiform (28.2%). The most common locations were the vertebral (51.7%) and basilar arteries (22.8%). Complete or near-complete occlusion (>90%) was achieved in 90.9% of aneurysms at a median follow-up of 12 mo. Dissecting/blister aneurysms were most likely to occlude (P =.06). Symptomatic neurologic complications occurred in 9.4% of aneurysms, associated with larger size, ruptured presentation, presentations with brain stem compression, cranial nerve palsy, or stroke. Favorable functional outcome (modified Rankin Score 0-2) was achieved in 86.2% of patients. There were 6 fatalities of which 4 occurred in aneurysmal subarachnoid hemorrhage patients. CONCLUSION: This multicenter study shows that PED for the treatment of posterior circulation is preferentially used for the treatment of fusiform and dissecting/blister aneurysm morphologies. Despite the challenges presented by these less-common morphologies, flow diversion may be performed with a neurologic complication rate of about 10% and favorable long-term aneurysm occlusion rates.
AB - BACKGROUND: The Pipeline Embolization Device (PED; Medtronic) has been used off-label for the treatment of challenging posterior circulation aneurysms. Data on this modality are primarily limited to small retrospective single-center series. OBJECTIVE: To assess safety and efficacy of this treatment by establishing an international, multicenter collaboration. METHODS: Consecutive posterior circulation aneurysms treated with the PED from 2012 to 2019 across 11 neurovascular centers were retrospectively reviewed. Baseline demographics, aneurysm and treatment characteristics, complications, occlusion status, and functional outcome were assessed. RESULTS: There were 149 posterior circulation aneurysms treated with PED in 146 patients. A total of 24 (16.4%) patients presented with subarachnoid hemorrhage. Most aneurysms were dissecting/blister (36.2%) in morphology, followed by saccular (35.6%) and fusiform (28.2%). The most common locations were the vertebral (51.7%) and basilar arteries (22.8%). Complete or near-complete occlusion (>90%) was achieved in 90.9% of aneurysms at a median follow-up of 12 mo. Dissecting/blister aneurysms were most likely to occlude (P =.06). Symptomatic neurologic complications occurred in 9.4% of aneurysms, associated with larger size, ruptured presentation, presentations with brain stem compression, cranial nerve palsy, or stroke. Favorable functional outcome (modified Rankin Score 0-2) was achieved in 86.2% of patients. There were 6 fatalities of which 4 occurred in aneurysmal subarachnoid hemorrhage patients. CONCLUSION: This multicenter study shows that PED for the treatment of posterior circulation is preferentially used for the treatment of fusiform and dissecting/blister aneurysm morphologies. Despite the challenges presented by these less-common morphologies, flow diversion may be performed with a neurologic complication rate of about 10% and favorable long-term aneurysm occlusion rates.
KW - Aneurysm
KW - Endovascular
KW - Flow diversion
KW - Pipeline
KW - Pipeline Embolization Device
KW - Posterior circulation
KW - Vertebrobasilar disease
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U2 - 10.1093/neuros/nyaa277
DO - 10.1093/neuros/nyaa277
M3 - Article
C2 - 32629474
AN - SCOPUS:85097454009
SN - 0148-396X
VL - 87
SP - 1252
EP - 1261
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -