Safety and Efficacy of Coils in Conjunction With the Pipeline Flex Embolization Device for the Treatment of Cerebral Aneurysms

Zhang, Qianqian; Shao, Qiuji; Chang, Kaitao; Zhang, Hongyun; He, Yingkun; Andrade-Barazarte, Hugo; Sheng, Zhiyuan; Mo, Xiao; Zemmar, Ajmal; Li, Li; Li, Tianxiao

doi:10.3389/fneur.2021.651465

Cited by 10 publications

(8 citation statements)

References 27 publications

(38 reference statements)

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“…Third, coils adjunctive with PED are complementary, rather than competing, for cerebral aneurysm treatment ( 17 ). In a recent single-center study ( 18 ), with a very small subset of the same patients as the present study, it was reported that pipeline-assisted coiling increased the complete occlusion rate without increasing surgical complication rate. In terms of results, the surgical strategy we selected had similar results to the PREMIER study, which was more in line with China's national conditions.…”

Section: Discussionmentioning

confidence: 48%

Small and Medium-Sized Aneurysm Outcomes Following Intracranial Aneurysm Treatment Using the Pipeline Embolization Device: A Subgroup Analysis of the PLUS Registry

Zhang

et al. 2022

Front. Neurol.

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ObjectiveThe purpose of this work was to summarize the real-world safety and efficacy of Pipeline Embolization Device (PED) therapy for small and medium-sized intracranial aneurysms in China.MethodsPatients from the PED in China post-market multi-center registry study (PLUS) with aneurysms smaller than 12 mm were selected. Radiographic outcomes were assessed using digital subtraction angiography. Clinical outcomes included functional outcomes (modified Rankin Scale, MRS) in the early postoperative period ( ≤ 30 days) and early postoperative complications associated with PED therapy.ResultsA total of 652 patients with a combined 754 aneurysms were included in this study (mean age of 53.9 ± 10.3 years, 68.7% women). Mean aneurysm diameter was 6.78 ± 2.67 mm. Of the 687 stents deployed, 99.7% (685/689) were successfully deployed. In this study, 64.7% (488/754) of aneurysms were treated with only the PED, whereas 35.3% (266/754) were subjected to PED-assisted therapy. Radiographic outcome at the last follow-up (median time: seven months) was available for 64.3% (485/754) of the aneurysms. 82.5% (400/485) of aneurysms demonstrated complete occlusion (Raymond Roy Grade I). 81.4% (395/485) of aneurysms were found to meet the study's primary effectiveness outcome. At the early postoperative period, the mRS score was determined to be 0–2 vs. 3-6 in 98.2% (640/652) vs. 1.8% (12/652) of the cases, respectively. The combined major morbidity and mortality rate was 3.2% (21/652).ConclusionIn the largest study of PED therapy for small and medium-sized intracranial aneurysms to date, pipeline-assisted coil embolization was chosen more often than multiple stent implantation for aneurysm treatment, demonstrating good results, high surgical success rates, high occlusion rates, and low morbidity and mortality.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03831672.

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Section: Discussionmentioning

confidence: 48%

Small and Medium-Sized Aneurysm Outcomes Following Intracranial Aneurysm Treatment Using the Pipeline Embolization Device: A Subgroup Analysis of the PLUS Registry

Zhang

et al. 2022

Front. Neurol.

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“…Zhang et al compared 99 aneurysms with a pipeline embolization device (PED) and 41 aneurysms with PED combined with coiling. In these cases, the adjunctive coil embolization group obtained higher satisfactory angiography results (92.7 vs. 78.8%, P = 0.047) without increasing any periprocedural complications ( 22 ).…”

Section: Discussionmentioning

confidence: 92%

“…First, adjunctive coil embolization with the flow diversion technique can promote thrombus formation in the aneurysmal sac, thereby achieving a higher complete occlusion rate and preventing aneurysm rupture ( 25 ). Second, the change in flow hemodynamics caused by the deployment of coils can contribute to neointimal hyperplasia formation across the device construct and aneurysm orifice ( 22 ). Notably, the deployment of coils affects stent visibility and increases the complexity of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Tubridge flow diverter alone vs. Tubridge flow diverter and coils for the treatment of intracranial aneurysms: A propensity score matching analysis

Shi

Zhang

et al. 2022

Front. Neurol.

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BackgroundThe study was designed to assess the clinical performance of a tubridge flow diverter (TFD) in the treatment of intracranial aneurysms and to compare the efficacy and safety between intracranial aneurysms treated with TFD alone and TFD combined with coiling.MethodsIn this retrospective study, patients treated with the TFD alone or TFD combined with coiling between June 2018 to November 2022 were included. The patient demographics, the characteristics of the aneurysm, and the treatment outcomes between the two groups were compared. Propensity score matching was performed to match the variables with a significant difference between groups.ResultsIn the current study, data from 93 consecutive patients including 104 aneurysms treated with TFD were analyzed. In total, 43 patients with 49 aneurysms were treated with TFD alone, and 50 patients with 55 aneurysms were treated with TFD combined with coiling. Aneurysms in the TFD combined with the coiling group were larger (12.9 ± 8.6 vs. 8.7 ± 8.8 mm, P = 0.016) and more likely to be saccular (92.7% vs. 75.5%, P = 0.027) than in the TFD alone group. No significant difference was observed between the two groups in terms of perioperative complication rate. During the follow-up period, the complete occlusion rate in the TFD combined with the coiling group was higher (80.0% vs. 43.8%, P = 0.001) than in the TFD alone group. These results were further confirmed using a propensity score matching analysis.ConclusionTFD combined with coiling can be a safe and effective alternative option for the treatment of complex aneurysms. Given the potential risks of these therapeutic modalities, thus very careful consideration is required on an individual patient basis.

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“…Moreover, coils within the aneurysm dome can prevent possible herniation of the PED device into the aneurysm cavity. An increased aneurysm occlusion rate has been demonstrated in patients with cerebral aneurysms which had been treated with the PED device plus coils 37 . At six month-follow-up of patients with cerebral aneurysms treated with the PED device with or without coiling, the complete occlusion rate of aneurysms was 85.4% vs 71.7% for aneurysms treated with the PED device plus coils versus the PED device only 37 .…”

Section: Discussionmentioning

confidence: 99%

Safety and effect of pipeline flex embolization device for complex unruptured intracranial aneurysms

Chen

Gao

et al. 2023

Sci Rep

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To investigate the safety and short-term effect of Pipeline Flex devices in the treatment of complex unruptured intracranial aneurysms, a retrospective study was performed for patients with complex unruptured intracranial aneurysms who were treated with the Pipeline Flex embolization device (PED Flex device) combined with or without coiling. The clinical, endovascular, and follow-up data were analyzed. One hundred and thirty-one patients with 159 complex unruptured cerebral aneurysms were treated with the PED Flex device, with 144 Flex devices deployed. Periprocedural complications occurred in four patients, resulting in the complication rate of 3.1%, including ischemic complications in three patients (2.3%) and hemorrhagic complication in one (0.8%). At discharge, the mRS was 0 in 101 (77.1%) patients, 1 in 25 (19.1%), 2 in four (3.1%), and 4 in one (0.8%), with the good prognosis rate (mRS 0–2) of 99.2%. Clinical follow-up was carried out in 87 (66.4%) patients 3–42 months after the procedure, with the mRS of 0 in 78 (89.7%), 1 in five (5.7%), 2 in three (3.4%), and 4 in one (1.1%). No significant (P = 0.16) difference existed in the mRS at discharge compared with that at clinical follow-up. Angiographic follow-up was performed in 61 (46.7%) patients with 80 (50.3%) aneurysms at 3–40 months, with the OKM grade of D in 57 (71.3%) aneurysms, C in eight (10%), and B in 15 (18.8%). Asymptomatic instent stenosis occurred in four patients (6.6%). In conclusion: The treatment of complex intracranial aneurysms with the Pipeline Flex embolization device may be safe and effective, with a high complete occlusion rate, a decreased complication rate, and a good prognosis rate at medium follow-up.

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Safety and Efficacy of Coils in Conjunction With the Pipeline Flex Embolization Device for the Treatment of Cerebral Aneurysms

Cited by 10 publications

References 27 publications

Small and Medium-Sized Aneurysm Outcomes Following Intracranial Aneurysm Treatment Using the Pipeline Embolization Device: A Subgroup Analysis of the PLUS Registry

Small and Medium-Sized Aneurysm Outcomes Following Intracranial Aneurysm Treatment Using the Pipeline Embolization Device: A Subgroup Analysis of the PLUS Registry

Tubridge flow diverter alone vs. Tubridge flow diverter and coils for the treatment of intracranial aneurysms: A propensity score matching analysis

Safety and effect of pipeline flex embolization device for complex unruptured intracranial aneurysms

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