Pipeline Embolization Devices for the Treatment of Intracranial Aneurysms, Single-Center Registry: Long-Term Angiographic and Clinical Outcomes from 1000 Aneurysms. Issue 3 (7th June 2021)

• Record Type: Journal Article
• Authors: Lylyk, Ivan; Scrivano, Esteban; Lundquist, Javier; Ferrario, Angel; Bleise, Carlos; Perez, Nicolas; Lylyk, Pedro Nicolas; Viso, Rene; Nella-Castro, Rodolfo; Lylyk, Pedro
• Is Part Of: Neurosurgery. Volume 89:Issue 3(2021)
• Page Start: 443
• Page End: 449
• Publication Date: 2021-06-07
• Subjects: Flow diverter -- Follow-up studies -- Intracranial aneurysm -- Stroke -- Subarachnoid hemorrhage -- Pipeline Embolization Device; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyab183
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Prospective studies have established the safety and efficacy of the Pipeline TM Embolization Device (PED; Medtronic) for treatment of intracranial aneurysms (IA). OBJECTIVE: To investigate long-term outcomes from the Pipeline Embolization Devices for the Treatment of Intracranial Aneurysms (PEDESTRIAN) Registry. METHODS: The PEDESTRIAN Registry data were retrospectively reviewed, which included patients (March 2006 to July 2019) with complex IAs treated with PED. Patients with unfavorable anatomy and/or recurrence following previous treatment were included and excluded those with acute subarachnoid hemorrhage. The primary angiographic endpoint was complete occlusion and long-term stability. Clinical and radiological follow-up was performed at 3 to 6 mo, 12 mo, and yearly thereafter. RESULTS: A total of 835 patients (mean age 55.9 ± 14.7 yr; 80.0% female) with 1000 aneurysms were included. Aneurysms varied in size: 64.6% were small (≤10 mm), 25.6% were large (11-24 mm), and 9.8% were giant (≥25 mm). A total of 1214 PEDs were deployed. Follow-up angiography was available for 85.1% of patients with 776 aneurysms at 24.6 ± 25.0 mo (mean). Complete occlusion was demonstrated in 75.8% of aneurysms at 12 mo, 92.9% at 2 to 4 yr, and 96.4% at >5 yr. During the postprocedural period, modified Rankin Scale scores remained stable or improved in 96.2% of patients, with stability or improvement in 99.1% of patients >5 yr. The overall major morbidity and neurological mortality rate was 5.8%. CONCLUSION: This study demonstrated high rates of long-term complete aneurysm occlusion, stable or improved functional outcomes, and low rates of complications and mortality. Clinical and angiographic outcomes improved over long-term follow-up, demonstrating that endovascular treatment of IA with PED is safe and effective. Graphical Abstract: