Comparison of PED and FRED flow diverters for posterior circulation aneurysms: a propensity score matched cohort study.

BACKGROUND

Flow diversion is a common endovascular treatment for cerebral aneurysms, but studies comparing different types of flow diverters are scarce.

OBJECTIVE

To perform a propensity score matched cohort study comparing the Pipeline Embolization Device (PED) and Flow Redirection Intraluminal Device (FRED) for posterior circulation aneurysms.

METHODS

Consecutive aneurysms of the posterior circulation treated at 25 neurovascular centers with either PED or FRED were collected. Propensity score matching was used to control for age, duration of follow-up imaging, adjunctive coiling, and aneurysm location, size, and morphology; previously ruptured aneurysms were excluded. The two devices were compared for the following outcomes: procedural complications, aneurysm occlusion, and functional outcome.

RESULTS

A total of 375 aneurysms of the posterior circulation were treated in 369 patients. The PED was used in 285 (77.2%) and FRED in 84 (22.8%) procedures. Aneurysms treated with the PED were more commonly fusiform and larger than those treated with FRED. To account for these important differences, propensity score matching was performed resulting in 33 PED and FRED unruptured aneurysm pairs. No differences were found in occlusion status and neurologic thromboembolic or hemorrhagic complications between the two devices. The proportion of patients with favorable functional outcome was higher with FRED (100% vs 87.9%, p=0.04).

CONCLUSION

Comparative analysis of PED and FRED for the treatment of unruptured posterior circulation aneurysms did not identify significant differences in aneurysm occlusion or neurologic complications. Variations in functional outcomes warrant additional investigations.

Informations de copyright

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: Ajith Thomas: DSMB SCENT trial by STRYKER. Funds paid to institution.Ramesh Grandhi: Consultant for Medtronic neurovascular, BALT neurovascular and Cerenovus.Christoph Griessenauer: Consultant for Stryker and received research funding from Medtronic.Naci Kocer: Consultant and proctoring agreement with MicroVention.Philipp Taussky:Reply: Consultant for Medtronic, Stryker, Cerenovus.Peter Kan: Consultant for Stryker, Medtronic, MicroVention, and Cerenovus.Vincent Tutino: Co-founder of Neurovascular Diagnostics, Inc.Monika Killer: Research grant from MicroVention/Terumo.Waleed Brinjikji: Microvention and Cerenovus consultant.Tom Marotta: Medtronic proctoring.Timo Krings: Consultant for Stryker, Medtronic, Penumbra, Cerenovus. stockholder in Marblehead Inc, royalties from Thieme.Clemens Schirmer: Research Support from Penumbra. Shareholder in Neurotechnology Investors.Giuseppe Lanzino: Consultant for Superior Medical Editing and Nested Knowledge.Christian Ulfert: Consulting fees from Johnson & Johnson.Charles Matouk: Consultant for Medtronic, Penumbra, Silk Road MedicalMarkus Mohlenbruch: Consultant for Medtronic, MicroVention, Stryker. Grants/grants pending: Balt (money paid to the institution), MicroVention (money paid to the institution). Payment for lectures includings service on speakers bureaus: Medtronic, MicroVention, and Stryker.Marshall Cress: Consulting for Cannon and Cerenovus.None related to this study and none are declared for the reminder of the authors.