Introduction: Flow diverters are increasingly used for treatment of intracranial aneurysms. We evaluated the clinical and angiographic outcomes after pipeline embolization device (PED) placement for treatment of intracranial aneurysms during the initial PED experience at four separate institutions.
Methods: We retrospectively examined PED placements to treat 68 aneurysms in 65 patients at 4 separate centers. Patient characteristics and outcomes were analyzed using univariate and multivariate models. Primary outcome was complete occlusion of the aneurysm at last follow-up. Secondary outcomes were any major complication (ischemic stroke, hemorrhagic stroke, or death) as well as a composite measure of all complications.
Results: The mean aneurysm size treated was 11.5 ± 7.5mm. Ten patients (15%) had previously sustained a subarachnoid hemorrhage, and 20 (29%) had been previously treated. All but 6 aneurysms (91%) arose from the anterior circulation, with the most common locations being paraophthalmic (35%) and cavernous segments (29%). Intracranial hemorrhage occurred in 4 patients (6%), and caused 2 deaths within 2 months of surgery. Technically successful placement was achieved for 65 aneurysms (96%). Among 52 cases with at least 6 months of radiographic follow-up, complete aneurysmal obliteration was observed in 34 patients (65%). Univariate analysis showed that a history of SAH (p=0.04) and pretreatment stenosis (p=0.001) predicted failure to occlude the aneurysm at six months, however neither were independently significant predictors in the multivariate model. COPD was an independent predictor of major complications (p=0.04; odds ratio 8.8). COPD and absence of preoperative therapeutic P2Y12 reaction unit (PRU) level were independent predictors of all complications (COPD p=0.03, OR 10.6; no preoperative therapeutic PRU level p=0.05, OR 6.9).
Conclusions: We describe the initial experience of PED use in Michigan. Further studies and long-term follow-up are needed to determine optimal treatment strategies for PED use.
Patient Care: Knowledge of the initial PED occlusion and complication rates in a multicenter study of early PED use informs treatment decisions for patients with difficult to treat aneurysms.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe patient and aneurysm characteristics of the initial post-market PED cohort, 2) Describe expected rates of complications and post-PED aneurysm occlusion, 3) Identify risk factors for post-PED complications.