Comparison of the Pipeline embolisation device alone or combined with coiling for treatment of different sizes of intracranial aneurysms

Abstract

ObjectivesThe aim of this study was to compare complications and outcomes between intracranial aneurysms treated with the Pipeline embolisation device (PED) alone or with PED combined with coiling for different-sized aneurysms.MethodPatients with aneurysms treated by PED were collected from the PED in China postmarket multicentre registry study. We performed a propensity match analysis to compare the efficacy and safety between PED alone and PED combined with coiling treatment, and then aneurysms were organised into three groups based on their size: small (≤7 mm), medium (≤15 mm to >7 mm) and large/giant (>15 mm). Complications and aneurysm occlusion rates in the aneurysm size groups were compared between PED alone and PED combined with coiling patients.ResultA total of 1171 patients with 1322 aneurysms were included. All patients received clinical follow-up, while angiographic follow-up was available in 967 aneurysms. For small aneurysms, there was no difference in the aneurysm occlusion rate between two groups (79.1% vs 88.4%, respectively), while there was a significant increase in the ischaemic complication rate (8.3% vs 19.3%, respectively, p=0.0001). For medium and large/giant saccular aneurysms, PED combined with coiling significantly improved the occlusion rate (medium aneurysms: 74.7% vs 88.8%, respectively, p<0.0001; large/giant saccular aneurysms: 72.9% vs 86.9%, respectively, p=0.018), while there were no differences in the total complication rate. For large/giant non-saccular aneurysms, two groups showed no differences.ConclusionUse of the PED with adjunctive coils can significantly improve the occlusion rate of medium aneurysms, without increasing the total complication rate.

Flow diversion for posterior circulation aneurysms: a multicenter retrospective study

“…Aneurysms in the anterior circulation have previously been reported to be improved by FD-assisted coiling. 41 , 42 However, this trend was not observed in the current study. As a result of the low aneurysm rupture rate, adding coiling to FD treatment theoretically provides immediate aneurysm dome protection against rupture.…”

Use of the Neuroform Atlas stent for wide-necked cerebral aneurysms

“…Flow diverters have been approved for endovascular treatment of medium-sized cerebral aneurysms, and in the current literature, flow diverters have been applied to treat both small- and medium-sized cerebral aneurysms 20 – 23 . In a study investigating the Pipeline flow diverter alone or combined with coiling for treatment of cerebral aneurysms with different sizes in a large cohort of 1171 patients with 1322 aneurysms 23 , angiographic follow-up did not show any difference in the aneurysm occlusion rate between the Pipeline Embolizing Device (PED) alone and PED combined with coiling in small aneurysm ≤ 7 mm in diameter (79.1% vs 88.4%, respectively) even though a significant increase in the ischemic complication rate was detected in the treatment with the PED combined with coiling (19.3% vs. 8.3%, P = 0.0001). For medium and large or giant saccular aneurysms, the PED combined with coiling had significantly increased the aneurysm occlusion rate (88.8% vs. 74.7% with a P < 0.0001 for medium sized aneurysms ≤ 15 mm and 86.9% vs. 72.9% with a P = 0.018 for large and giant aneurysms > 15 mm) as compared with the PED deployment alone even though the complication rate was not significantly different.…”

Flow diversion effect of the leo braided stent for aneurysms in the posterior and distal anterior circulations: A multicenter cohort study

“…Intraoperative aneurysm rupture is one of the significant risk factors for early serious complications ( 17 ), and the risk of intraprocedural rupture is significantly high during coiling, especially in heteromorphic or very small aneurysms ( 31 , 32 ). Flow velocity in the aneurysm and wall shear stress are two important hemodynamic parameters associated with the growth and rupture of intracranial aneurysms ( 7 , 8 ), and could be eliminated by coiling the aneurysm more intuitively ( 33 , 34 ). In our study, two cases with acute cerebral hemorrhage were all in the SAC group, in our experience, complicated aneurysms treated with Leo-assisted coiling could not be packed too densely.…”