Introduction: Flow diversion via Pipeline Embolization Device (PED) has become a primary treatment modality for intracranial aneurysms. Coiling in conjunction with PED placement could provide immediate dome protection and an intra-aneurysmal scaffold to prevent device prolapse for aneurysms with high rupture risk and complex anatomy. The safety and efficacy of dual modality treatment has not been well studied.
Methods: In this case-controlled study, clinical and radiographic records of all patients who underwent PED treatment at a single institution between 2011 and 2013 were retrospectively reviewed.
Results: From 2011-2013, 29 patients were treated with PED and coils and 75 with PED only. There were no differences between the 2 groups in terms of age, gender, aneurysm location, medical co-morbidity, and length of follow-up. Those aneurysms treated by PED with coils were larger (16.3mm vs. 12.4mm,p=0.02) and more likely to be ruptured (20.7% vs. 1.3%,p=0.001) or dissecting (34.5% vs. 9.3%,p=0.002). PED deployment was successful in all cases, and post-operative angiography was performed for all patients. At the latest follow-up, complete aneurysm occlusion was achieved at a higher proportion in those treated by PED with coils (93.1%) than in PED only group (74.7%,p=0.03). Device foreshortening or migration occurred in 4 patients from PED only group and none from PED with coils group, and fewer patients required retreatment in PED with coils group (3.4%) compared with PED only group (16.0%,p=0.05). The rate of neurological complication and favorable outcome (mRS=0-2) was similar in both groups (10.3% vs. 8.0%, p=0.7; 93.1% vs. 94.7%, p=0.6, respectively).
Conclusions: The combination of PED and coiling can be used safely and effectively in treating aneurysms with high risk of rupture and complex anatomy. Conjunctive coiling with PED placement provides higher aneurysm occlusion rate and reduces the need for retreatment. Investigations with long-term results are needed to further evaluate the benefits of dual modality treatment.
Patient Care: Our study aims to evaluate the safety and efficacy of using coils in conjunction with PED for the treatment of intracranial aneurysms with high rupture risk and complex anatomy. Understanding the indication, risks, and benefits of dual modality treatment can help vascular and endovascular neurosurgeons to better decide the type of treatment a patient needs and provide opportunities for outcome improvement.
Learning Objectives: To understand the indication, risks, and benefits of using coils in conjunction with PED placement for the treatment of intracranial aneurysms. To understand the subgroups of patients based on clinical and aneurysmal properties for whom dual modality treatment is benefitial.