Introduction: The advent of flow diversion for the treatment of cerebral aneurysms has revolutionized the field of endovascular neurosurgery. As more experience has been gained with the use of this new technology, questions remain as to the utility of adjunctive coil embolization. Because the addition of coils potentially increases the time and complexity of these procedures, we wished to determine if there was an increase in complications associated with this technique.
Methods: The IntrePED registry was reviewed for patients treated with the Pipeline Embolization Device (PED, Covidien/eV3 Neurovascular, Irvine, California) alone versus those treated with concurrent coil embolization (PED/Coil). Basic patient demographic information, aneurysm characteristics, and complications were examined.
Results: Six hundred and eighty nine patients with 797 aneurysms were treated with PED alone versus 104 patients with 109 aneurysms treated with PED/Coil in this dataset. Mean aneurysm size was statistically larger in the PED/Coil cohort (13.6 ± 7.8 mm vs. 10.3 ± 7.6). Additionally, there was a statistically significant increase in procedure times with PED/Coil (135.2 min ± 64.4 vs. 96.6 ± 46.2). There was no statistically significant difference in the major neurological morbidity and mortality (PED/Coil 12.5% vs. PED alone 7.8%) with either treatment strategy.
Conclusions: While adjunctive coil embolization with PED increases procedural times, it did not significantly increase the major neurological morbidity and mortality rate associated with this procedure. Based upon these results, we believe that the use of adjunctive coil embolization with PED use is a reasonable treatment strategy from a safety standpoint. The overall utility, however, will require further examination of treatment efficacy before any definitive recommendations can be made.
Patient Care: This research will provide practitioners a more complete understanding of the risks involved with a strategy of use of flow diverting stents with and without adjunctive coil embolization in the treatment of cerebral aneurysms.
Learning Objectives: By the conclusion of this session, the participant should learn about 1.) different treatment strategies for use of flow diverting stents in the treatment of cerebral aneurysms and 2.) the complication rates associated with these strategies.