Age-related outcomes following intracranial aneurysm treatment with the Pipeline Embolization Device: a subgroup analysis of the IntrePED registry

Abstract

A dvAncing age is a well-known risk factor for periprocedural morbidity and mortality after both surgery and coil embolization of intracranial aneurysms. 4,11,13 Flow diversion is a more recently developed endovascular technique, and several single-center and multicenter series have reported encouraging early results, especially in the treatment of complex proximal internal carotid artery (ICA) aneurysms.1-3 However, given the relatively small size of these series, the effect of age on periprocedural complication rates and long-term clinical outcomes after flow diversion is difficult to establish. The International Retrospective Study of the Pipeline Embolization Device (IntrePED) is a large multicenter study conducted to assess the incidence of periprocedural complications after Pipeline (Medtronic) embolization of intracranial aneurysms in a "real world" scenario. 8 This study provided us with a unique opportunity to assess the influence of advancing age on perioperative complications after flow diversion for intracranial aneurysms. In this study, we report age-related complications of IntrePED methods Patients with unruptured aneurysms in the IntrePED registry were divided into 4 age groups: ≤ 50, 51-60, 61-70, and > 70 years old. The rates of the following postoperative complications were compared between age groups using chi-square tests: spontaneous rupture, intracranial hemorrhage (ICH), ischemic stroke, parent artery stenosis, cranial neuropathy, neurological morbidity, neurological mortality, combined neurological morbidity and mortality, and all-cause mortality. The association between age and these complications was tested in a multivariate logistic regression analysis adjusted for sex, number of PEDs, and aneurysm size, location, and type. results Seven hundred eleven patients with 820 unruptured aneurysms were included in this study. Univariate analysis demonstrated no significant difference in ICH rates across age groups (lowest 1.0% for patients ≤ 50 years old and highest 5.0% for patients > 70 years old, p = 0.097). There was no difference in ischemic stroke rates (lowest 3.6% for patients ≤ 50 years old and highest 6.0% for patients 50-60 years old, p = 0.73). Age > 70 years old was associated with higher rates of neurological mortality; patients > 70 years old had neurological mortality rates of 7.4% compared with 3.3% for patients 61-70 years old, 2.7% for patients 51-60 years old, and 0.5% for patients ≤ 50 years old (p = 0.006).On multivariate logistic regression analysis, increasing age was associated with higher odds of combined neurological morbidity and mortality (odds ratio 1.02, 95% confidence interval 1.00-1.05; p = 0.03). coNclusioNs Increasing age is associated with higher neurological morbidity and mortality after Pipeline embolization of intracranial aneurysms. However, the overall complication rates of PED treatment in this group of highly selected elderly patients (> 70 years) were acceptably low, suggesting that age alone should not be considered an exclusion criterion when co...

Predictors of Incomplete Occlusion following Pipeline Embolization of Intracranial Aneurysms: Is It Less Effective in Older Patients?

“…Increased age was also associated with higher odds of neurologic morbidity. 20 Our data found a nonsignificant trend toward increased complications in patients older than 70 years of age.…”

“…As one might expect, as patients age, the risk of complications appears to increase. Brinjikji et al, 20 in a large multicenter study on complications associated with PED placement, found that complication rates rise as the patient age increases. Patients older than 70 years of age had significantly higher rates of neurologic mortality.…”

Risk factors of acute coagulation dysfunction after aneurysmal subarachnoid hemorrhage

“…Operation possesses a significant risk of neurological dysfunction and death in patients > 65 years of age with unruptured intracranial aneurysms [20] . Increasing age is associated with higher neurological morbidity and mortality after pipeline embolization of intracranial aneurysms [21]. And in the study, age more than 65 years was an independent risk factor for coagulopathy and associated with higher mortality after aneurysm clipping.…”

On Flow Diversion: The Changing Landscape of Intracerebral Aneurysm Management

“…23 The fusiform aneurysm was the only variable independently associated with postoperative stroke. 24 The PED is being used increasingly for off-label indications. For posterior circulation aneurysms, subgroup analysis from the IntrePED safety series showed neurologic morbidity and mortality comparable with reported rates after clipping or coiling.…”