Factors Affecting the Obliteration Rate of Intracranial Aneurysms Treated with a Single Pipeline Embolization Device

Abstract

Objective To evaluate the clinical and angiographic outcomes of intracranial aneurysm treatment using a single Pipeline Embolization Device (PED), and to evaluate the factors affecting aneurysm obliteration rate. Methods The demographic characteristics and anatomical features of 58 aneurysms in 47 patients treated with a single Pipeline embolization device were reviewed retrospectively. All aneurysms treated with one PED at a single center, and with follow-up angiograms of at least six months were included in this study. Results The overall rate of complete and near-complete occlusion was 84% (49/58) after a mean follow-up period of 18.3 months. The complete aneurysm obliteration rate was reduced when an arterial branch arose from the aneurysm neck; 13% (1/8) compared with 68% (34/50) for aneurysms without an arterial branch (P value: 0.0075). The overall complete and near-complete aneurysm occlusion rate was 90% (45/50) in aneurysms without an arterial branch arising from its neck. There was no statistically significant association between neck-width, aneurysm size, type, or history of prior coil embolization on obliteration rate. Conclusions Our data suggests that a single PED is sufficient to induce complete or near-complete obliteration of most aneurysms. The presence of a branching artery arising from the aneurysm neck is highly predictive of incomplete occlusion after treatment with a single PED.

Relationship between haemodynamic changes and outcomes of intracranial aneurysms after implantation of the pipeline embolisation device: a single centre study

“…34 In the present study, the mean aneurysm size was larger in the ICO group than in the CO group; however, although significant in univariate analysis, this difference was not significant according to multivariate regression analysis. Numerous other studies of FDs have shown a tendency towards decreasing occlusion rates with increasing aneurysm size; 30,39,40 however, in most series, this tendency has not been statistically significant, as was the case in the present study. Large aneurysms take longer to thrombose and may have complex flow patterns as a result of pulsatile flow, resulting in coil changes.…”

Flow diverter devices in the treatment of posterior communicating artery aneurysms: mid-term clinical and radiological outcomes

“…The presence of incorporated artery increases difficulties in endovascular treatment of the aneurysm; flow diverters provided a solution for those aneurysms [31]; we identified that incorporated vessels from the aneurysmal sac/neck is an independent predictor of incomplete aneurysm occlusion, the same announced in many studies [14,22,[32][33][34][35]. It is explained by pressure gradient kept by incorporated branch toward the aneurysm that reduced the flow diversion effect of the stent and in PCOM aneurysm theoretical explanation by retrograde filling of the sac via the posterior circulation resulting in residual aneurysm filling after treatment [22].…”

“…A lager aneurysmal size is associated with low occlusion rate the same realized in many studies [9,27,32,34,36,37]. Fetal origin PCOM artery almost always associated with failure of aneurysm occlusion [14][15][16][17]; it explains by high demand flow in largecaliber fetal PCOM artery keep the flow to it and disrupt the flow diversion effect.…”

On Flow Diversion: The Changing Landscape of Intracerebral Aneurysm Management

“…8 Relatively limited data show that a single device results in complete or near-complete occlusion of most aneurysms, including those at bifurcations, without delayed complications or mortality. 9,10 A second-generation version, the Pipeline Flex, was approved in Europe in 2014 and the United States in 2015. While the device itself is identical to the original, the delivery system was enhanced to improve device deployment and provide additional safety by incorporating a resheathing feature (Fig 1 and On-line Table 1).…”