International retrospective study of the pipeline embolization device: A multicenter aneurysm treatment study

David F. Kallmes, R. Hanel, D. Lopes, E. Boccardi, A. Bonafé, S. Cekirge, D. Fiorella, P. Jabbour, E. Levy, C. McDougall, A. Siddiqui, I. Szikora, H. Woo, F. Albuquerque, H. Bozorgchami, S. R. Dashti, J. E.Delgado Almandoz, M. E. Kelly, R. I. Turner, B. K. WoodwardW. Brinjikji, G. Lanzino, P. Lylyk

Research output: Contribution to journalArticle

Abstract

Background and Purpose: Flow diverters are increasingly used in the endovascular treatment of intracranial aneurysms. Our aim was to determine neurologic complication rates following Pipeline Embolization Device placement for intracranial aneurysm treatment in a real-world setting. Materials and Methods: We retrospectively evaluated all patients with intracranial aneurysms treated with the Pipeline Embolization Device between July 2008 and February 2013 in 17 centers worldwide. We defined 4 subgroups: internal carotid artery aneurysms of ≥10 mm, ICA aneurysms of<10 mm, other anterior circulation aneurysms, and posterior circulation aneurysms. Neurologic complications included spontaneous rupture, intracranial hemorrhage, ischemic stroke, permanent cranial neuropathy, and mortality. Comparisons were made with t tests or ANOVAs for continuous variables and the Pearson x2 or Fisher exact test for categoric variables. Results: In total, 793 patients with 906 aneurysms were included. The neurologic morbidity and mortality rate was 8.4% (67/793), highest in the posterior circulation group (16.4%, 9/55) and lowest in the ICA<10-mm group (4.8%, 14/294) (P=.01). The spontaneous rupture rate was 0.6% (5/793). The intracranial hemorrhage rate was 2.4% (19/793). Ischemic stroke rates were 4.7% (37/793), highest in patients with posterior circulation aneurysms (7.3%, 4/55) and lowest in the ICA <10-mm group (2.7%, 8/294) (P = .16). Neurologic mortality was 3.8% (30/793), highest in the posterior circulation group (10.9%, 6/55) and lowest in the anterior circulation ICA<10-mm group (1.4%, 4/294) (P<.01). Conclusions: Aneurysm treatment with the Pipeline Embolization Device is associated with the lowest complication rates when used to treat small ICA aneurysms. Procedure-related morbidity and mortality are higher in the treatment of posterior circulation and giant aneurysms.

Original languageEnglish (US)
Pages (from-to)108-115
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume36
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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    Kallmes, D. F., Hanel, R., Lopes, D., Boccardi, E., Bonafé, A., Cekirge, S., Fiorella, D., Jabbour, P., Levy, E., McDougall, C., Siddiqui, A., Szikora, I., Woo, H., Albuquerque, F., Bozorgchami, H., Dashti, S. R., Almandoz, J. E. D., Kelly, M. E., Turner, R. I., ... Lylyk, P. (2015). International retrospective study of the pipeline embolization device: A multicenter aneurysm treatment study. American Journal of Neuroradiology, 36(1), 108-115. https://doi.org/10.3174/ajnr.A4111