Introduction: Pipeline Embolization Device (PED), is safe and effective in management of intracranial aneurysms. Recently the indication of use has expanded from wide neck, large complex aneurysms to small aneurysms of anterior and posterior circulation as well. Despite higher complete occlusion rate ,it is important to understand the factors associated with incomplete occlusion. In this study, we analyzed a series of risk factors to determine the predictors of incomplete aneurysm occlusion after PED treatment.
Methods: Our study was approved by the local IRB. From March 2009 to April 2014, a retrospective review of the patients treated with PED in our institute was performed. Patients without angiographic follow-up were excluded in this study. Aneurysm obliteration was categorized as complete (100%), near-complete (=90%) or incomplete (<90%) at the time of latest follow-up. All cases were divided into two groups: adequately occluded group (completely occluded aneurysms and near-completely occluded aneurysms) and incompletely occluded group. Data, such as patient factors, aneurysm factors and procedure factors, were collected for univariate statistical analysis. Multivariate binary logistic regression analysis was performed using SPSS software(IBM version 21) to find predictors of incomplete occlusion.
Results: 129 aneurysms were included with a mean follow-up of 7.89 months. One hundred and four aneurysms (80.6%) had near complete or complete occlusion (94 were complete occlusion and 10 were near-complete occlusion) and 25 aneurysms (19.4%) had incomplete occlusion. Two (1.6%) aneurysms recanalized during the follow-up. In the univariate analysis, the intra-aneurysmal thrombus, large aneurysm and posterior circulation aneurysm were associated with incomplete occlusion(p<0.05). Varied factors were fed in the regression model:Partially thrombosed aneurysm (p=0.04, OR .64,CI 0.564 - .789) along with aneurysm >20mm(p=0.02, OR 0.78, CI 0.543- 0.876) were significantly associated with incomplete occlusion.
Conclusions: The endovascular treatment with PED is an effective therapy with high aneurysm occlusion rate. The intra-aneurysmal thrombus and aneurysms >20mm were associated with incomplete occlusion.
Patient Care: It will help the clinician to identify potential aneurysms that will be prone for incomplete occlusion.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of risk factors associated with incomplete occlusion of aneurysms following PED placement 2) Discuss, in small groups about the complications 3) Identify an effective treatment of cerebral aneurysms