Introduction: Stent-assisted coil embolization and flow diversion with the Pipeline embolization device (PED) are both safe and effective endovascular treatment options for ophthalmic segment aneurysms (OSA) of the internal carotid artery. Here we present the largest cohort study comparing stent-coiling and PED for OSA.
Methods: Two academic institutions in the United States contributed a prospectively maintained data on consecutive patients with OSA treated with either stent-coiling between 2007 and 2015 or PED placement between 2011 and 2015.
Results: The total number of OSA treated with PED and stent-coiling at the two institutions was 62 and 68, respectively. Aneurysms treated with stent-coiling had a larger maximum diameter (p = 0.00042), neck size (p = 0.000001), height (p = 0.001), and width (p = 0.00046). Complete occlusion upon last follow up was achieved in 75.9% and 78% of aneurysms treated with stent-coiling and PED, respectively (p = 0.826). Complete occlusion in the PED group who had more than 1-year follow-up was achieved in 84.2%, compared to 74.4% in the stent-coiling group (p = 0.513). Good functional outcome was achieved in 96.4% and 94.9% of patients, respectively (p = 0.679). The rate of complications for stent-coiling and PED were 9.7% and 14.7%, respectively (p = 0.433). Complete occlusion after stent-coiling was associated with non-smokers (p = 0.026), and smaller aneurysm diameter (0.016), neck size (0.008), height (0.009), and width (0.007). Aneurysm measurements were not associated with complete occlusion in aneurysms treated with PED.
Conclusions: Stent-coiling and PED were safe and equally effective in treatment of OSA. Even though stent-coiling was used in relatively larger aneurysms, there were no significant differences in terms of procedural complications, angiographic, functional, and visual outcomes. Occlusion rate after PED continued to improve up to 1 year of follow-up. PED is also technically more favorable to preform compared to stent-coiling, especially for smaller aneurysms, and it may remodel dysmorphic parent vessels.
Patient Care: By determining the most safe and effective treatment of ophthalmic segment aneurysms.
Learning Objectives: 1- To compare the safety and efficacy of pipeline versus stent-coil in treatment of ophthalmic segment aneurysm.
2- To determine the effect of patient's and aneurysm's characteristics on surgical and clinical outcomes.