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

Zhang, Hongyun; Li, Li; Zhang, Hongqi; Liu, Jianmin; Song, Dong Ho; Zhao, Yuanli; Guan, Sheng; Maimaitili, Aisha; Wang, Yunyan; Feng, Wenfeng; Wang, Yan; Wan, Jieqing; Mao, Guohua; Shi, Huaizhang; Luo, Bin; Shao, Qiuji; Chang, Kaitao; Zhang, Qianqian; He, Yingkun; Zhang, Peng; Yang, Xinjian; Li, Tian xiao

doi:10.3389/fneur.2022.881353

Cited by 9 publications

(6 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The PREMIER study is the first prospective multicenter study to evaluate the use of flow diverters in small/medium, unruptured intracranial aneurysms, which suggests that treatment with the flow-diverting pipeline embolization device is safe and efficacious for small aneurysms, with complication rates comparable with those for traditional endovascular techniques ( 3 ). Another real-world study about the safety and efficacy of the pipeline embolization device for small/medium intracranial aneurysms in China also demonstrated high surgical success rates, high occlusion rates, and low morbidity and mortality ( 4 ). Therefore, the indication of flow diversion is extended to small and medium aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Tubridge flow diverter for the treatment of small and medium aneurysms

et al. 2023

View full text Add to dashboard Cite

BackgroundTubridge flow diverter is a widely used device aimed at reconstructing parent arteries and occluding complex aneurysms in China. The experience of Tubridge in treating small and medium aneurysms is still limited. In this study, we aimed to evaluate the safety and efficacy of the Tubridge flow diverter for the treatment of the two types of aneurysms.MethodsWe reviewed the clinical records of aneurysms treated with a Tubridge flow diverter between 2018 and 2021 in a national cerebrovascular disease center. Cases were divided into small and medium aneurysms according to aneurysm size. The therapeutic process, occlusion rate, and clinical outcome were compared.ResultsIn total, 57 patients and 77 aneurysms were identified. The patients were divided into two groups: small aneurysms (39 patients, 54 aneurysms) and medium aneurysms (18 patients, 23 aneurysms). There were 19 patients with tandem aneurysms (a total of 39 aneurysms) in the two groups, among which 15 patients (30 aneurysms) were in the small aneurysm group and four patients (nine aneurysms) were in the medium aneurysm group. The results show that the mean maximal diameter/neck in the small and medium aneurysms was 3.68/3.25 and 7.61/6.24 mm, respectively. In total, 57 Tubridge flow diverters were successfully implanted without unfolding failure, and there were six patients with new mild cerebral infarction in the small aneurysm group. The complete occlusion rate on the last angiographic follow-up was achieved in 88.46% of the small aneurysms group and 81.82% of the medium aneurysms group. The complete occlusion rate of patients with tandem aneurysms in the last angiographic follow-up was 86.67% (13/15) of the small aneurysms group and 50% (2/4) of the medium aneurysm group. Intracranial hemorrhage was nonencountered in the two groups.ConclusionOur preliminary experience suggests that the Tubridge flow diverter might be a safe and effective treatment for small and medium aneurysms along the internal carotid artery. Long stents may increase the risk of cerebral infarction. Adequate evidence is required to clarify the definite indications and complications in a multicenter randomized controlled trial with a long-term follow-up.

show abstract

Section: Discussionmentioning

confidence: 99%

Tubridge flow diverter for the treatment of small and medium aneurysms

et al. 2023

View full text Add to dashboard Cite

show abstract

“…With continuous progress in endovascular treatment technology and concept, as well as rapid development in new materials and equipment, endovascular treatment technology has been widely used in the treatment of intracranial aneurysms. Compared with surgical clipping, interventional embolization of aneurysms has the advantages of less trauma, faster recovery, and lower surgical risk, and has been accepted by the majority of patients as one of the first choices for the treatment of intracranial aneurysms ( 25 , 27 – 31 ). However, the recurrence rate was significantly higher than that of surgical clipping ( 2 , 19 – 21 ), with the recurrent ruptured hemorrhage of embolized aneurysms characterized by high mortality and disability, requiring repeated endovascular embolization.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for repeated recurrence of cerebral aneurysms treated with endovascular embolization

Han

Jiang²,

Tian³

et al. 2022

Front. Neurol.

View full text Add to dashboard Cite

PurposeTo explore the risk factors of recurrence after second endovascular embolization of recurrent aneurysms and the characteristics of recurrent refractory aneurysms to help clinical decision-making.Materials and methodsForty-nine patients with recurrent aneurysms who underwent repeated embolization were retrospectively enrolled and divided into the recurrent and non-recurrent group. The risk factors of recurrence, complications and follow-up results of repeated embolization, and characteristics of recurrent refractory aneurysms were analyzed.ResultsAmong the 49 patients with the second embolization, 5 were lost to follow-up, 9 recurred, and 35 did not. Univariate analysis showed that aneurysm size (P = 0.022), aneurysm classification (P = 0.014), and Raymond-Roy grade after the second embolization (P = 0.001) were statistically different between the two groups. Multivariate analysis demonstrated the Raymond-Roy grade as an independent risk factor for the recurrence of aneurysms after the second embolization (P = 0.042). The complication rate after the second embolization was 4%. There were five recurrent refractory aneurysms with an average aneurysm size of 23.17 ± 10.45 mm, including three giant aneurysms and two large aneurysms. To achieve complete or near-complete embolization of the recurrent refractory aneurysms, multiple treatment approaches were needed with multiple stents or flow diverting devices.ConclusionAneurysm occlusion status after the second embolization is an independent risk factor for the recurrence of intracranial aneurysms. Compared with near-complete occlusion, complete occlusion can significantly reduce the risk of recurrence after second embolization. In order to achieve complete or near-complete occlusion, recurrent refractory aneurysms need multiple treatments with the use of multiple stents or flow diverting devices.

show abstract

“…In the treatment of the anterior circulation, PED has demonstrated a good therapeutic effect. 6,7 Nowadays, the use of PED in posterior circulation aneurysms is gradually increasing. However, the proportion of nonsaccular aneurysms in the posterior circulation and the risk of aneurysm rupture were higher, 1,2 and the clinical grade at the time of rupture was poor.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Flow diversion devices have achieved good results in the treatment of anterior circulation and have become a common treatment method for intracranial aneurysms . 6,7 Currently, there are more and more cases of PED off-label treatment for posterior circulation aneurysms. However, endovascular treatment of posterior circulation aneurysms has more complications than anterior circulation aneurysms, 8 so the selection of appropriate treatment segments is crucial.…”

mentioning

confidence: 99%

Pipeline Embolization Device for Small and Medium Vertebral Artery Aneurysms: A Multicenter Study

Zhang

Liu

et al. 2022

Neurosurgery

Self Cite

View full text Add to dashboard Cite

BACKGROUND:Pipeline embolization devices (PEDs) have been increasingly used for the treatment of posterior circulation aneurysms.OBJECTIVE:To investigate the safety and efficacy of PED in the treatment of small to medium unruptured vertebral artery intracranial aneurysms (VAIAs).METHODS:Data from 76 patients with 78 unruptured small and medium (≤12 mm) VAIAs were analyzed. Data for this study come from the PLUS study, which was conducted at 14 centers in China from 2014 to 2019. Univariate analyses were performed to evaluate predictors of the occlusion and complication.RESULTS:Seventy-eight aneurysms in 76 patients were treated with PED. The mean aneurysm size was 8.28 ± 2.13 mm, and all PEDs were successfully placed. The median follow-up was 7 months and available for 67 (85.9%) aneurysms. Complete occlusion was seen in 60 (89.6%) aneurysms, which 86.6% met the primary efficacy outcome. All patients received clinical follow-up, the combined major morbidity and mortality was 2.6%, and 98.7% of patients had a good prognosis. Ischemic stroke occurred in 10.5% of patients, and adjuvant coil and successful after adjustment were predictors of ischemic stroke in the early postoperative and follow-up, respectively. There was no significant difference in the occlusion rate of aneurysm involving posterior inferior cerebellar artery (P = .78). In cases where posterior inferior cerebellar artery was covered by PED, there was no significant difference in ischemic stroke.CONCLUSION:In the treatment of unruptured ≤12 mm VAIAs, PED has a high surgical success rate, a high degree of occlusion, and low morbidity and mortality. PED may be a promising endovascular technique.

show abstract

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

Cited by 9 publications

References 20 publications

Tubridge flow diverter for the treatment of small and medium aneurysms

Tubridge flow diverter for the treatment of small and medium aneurysms

Risk factors for repeated recurrence of cerebral aneurysms treated with endovascular embolization

Pipeline Embolization Device for Small and Medium Vertebral Artery Aneurysms: A Multicenter Study

Contact Info

Product

Resources

About