TY - JOUR
T1 - Predictive factors of incomplete aneurysm occlusion after endovascular treatment with the Pipeline embolization device
AU - Maragkos, Georgios A.
AU - Ascanio, Luis C.
AU - Salem, Mohamed M.
AU - Gopakumar, Sricharan
AU - Gomez-Paz, Santiago
AU - Enriquez-Marulanda, Alejandro
AU - Jain, Abhi
AU - Schirmer, Clemens M.
AU - Foreman, Paul M.
AU - Griessenauer, Christoph J.
AU - Kan, Peter
AU - Ogilvy, Christopher S.
AU - Thomas, Ajith J.
N1 - Funding Information:
Dr. Kan is a consultant for Stryker Neurovascular and Medtronic Covidien. Drs. Maragkos and Ascanio are recipients of research financial support from Medtronic Inc., Cerebrovascular Group. Dr. Thomas is on the data safety monitoring board of Stryker; funds are paid to his institution.
Publisher Copyright:
© AANS 2020, except where prohibited by US copyright law.
PY - 2020/5
Y1 - 2020/5
N2 - OBJECTIVE The Pipeline embolization device (PED) is a routine choice for the endovascular treatment of select intracranial aneurysms. Its success is based on the high rates of aneurysm occlusion, followed by near-zero recanalization probability once occlusion has occurred. Therefore, identification of patient factors predictive of incomplete occlusion on the last angiographic follow-up is critical to its success. METHODS A multicenter retrospective cohort analysis was conducted on consecutive patients treated with a PED for unruptured aneurysms in 3 academic institutions in the US. Patients with angiographic follow-up were selected to identify the factors associated with incomplete occlusion. RESULTS Among all 3 participating institutions a total of 523 PED placement procedures were identified. There were 284 procedures for 316 aneurysms, which had radiographic follow-up and were included in this analysis (median age 58 years; female-to-male ratio 4.2:1). Complete occlusion (100% occlusion) was noted in 76.6% of aneurysms, whereas incomplete occlusion (≤ 99% occlusion) at last follow-up was identified in 23.4%. After accounting for factor collinearity and confounding, multivariable analysis identified older age (> 70 years; OR 4.46, 95% CI 2.30–8.65, p < 0.001); higher maximal diameter (≥ 15 mm; OR 3.29, 95% CI 1.43–7.55, p = 0.005); and fusiform morphology (OR 2.89, 95% CI 1.06–7.85, p = 0.038) to be independently associated with higher rates of incomplete occlusion at last follow-up. Thromboembolic complications were noted in 1.4% and hemorrhagic complications were found in 0.7% of procedures. CONCLUSIONS Incomplete aneurysm occlusion following placement of a PED was independently associated with age > 70 years, aneurysm diameter ≥ 15 mm, and fusiform morphology. Such predictive factors can be used to guide individualized treatment selection and counseling in patients undergoing cerebrovascular neurosurgery.
AB - OBJECTIVE The Pipeline embolization device (PED) is a routine choice for the endovascular treatment of select intracranial aneurysms. Its success is based on the high rates of aneurysm occlusion, followed by near-zero recanalization probability once occlusion has occurred. Therefore, identification of patient factors predictive of incomplete occlusion on the last angiographic follow-up is critical to its success. METHODS A multicenter retrospective cohort analysis was conducted on consecutive patients treated with a PED for unruptured aneurysms in 3 academic institutions in the US. Patients with angiographic follow-up were selected to identify the factors associated with incomplete occlusion. RESULTS Among all 3 participating institutions a total of 523 PED placement procedures were identified. There were 284 procedures for 316 aneurysms, which had radiographic follow-up and were included in this analysis (median age 58 years; female-to-male ratio 4.2:1). Complete occlusion (100% occlusion) was noted in 76.6% of aneurysms, whereas incomplete occlusion (≤ 99% occlusion) at last follow-up was identified in 23.4%. After accounting for factor collinearity and confounding, multivariable analysis identified older age (> 70 years; OR 4.46, 95% CI 2.30–8.65, p < 0.001); higher maximal diameter (≥ 15 mm; OR 3.29, 95% CI 1.43–7.55, p = 0.005); and fusiform morphology (OR 2.89, 95% CI 1.06–7.85, p = 0.038) to be independently associated with higher rates of incomplete occlusion at last follow-up. Thromboembolic complications were noted in 1.4% and hemorrhagic complications were found in 0.7% of procedures. CONCLUSIONS Incomplete aneurysm occlusion following placement of a PED was independently associated with age > 70 years, aneurysm diameter ≥ 15 mm, and fusiform morphology. Such predictive factors can be used to guide individualized treatment selection and counseling in patients undergoing cerebrovascular neurosurgery.
KW - Aneurysm
KW - Interventional neurosurgery
KW - Occlusion
KW - Pipeline embolization device
KW - Prognostic factors
KW - Vascular disorders
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U2 - 10.3171/2019.1.JNS183226
DO - 10.3171/2019.1.JNS183226
M3 - Article
C2 - 31026827
AN - SCOPUS:85084213501
SN - 0022-3085
VL - 132
SP - 1598
EP - 1605
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 5
ER -