Experience With the Pipeline Embolization Device for Posterior Circulations Aneurysms: A Multicenter Cohort Study.

Cohort Studies Embolization, Therapeutic / adverse effects Endovascular Procedures Follow-Up Studies Humans Intracranial Aneurysm / epidemiology Retrospective Studies Treatment Outcome
Aneurysm Endovascular Flow diversion Pipeline Pipeline Embolization Device Posterior circulation Vertebrobasilar disease

Journal

Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914

Informations de publication

Date de publication:
16 11 2020
Historique:
received: 20 12 2019
accepted: 23 04 2020
pubmed: 7 7 2020
medline: 6 1 2022
entrez: 7 7 2020
Statut: ppublish

Résumé

The Pipeline Embolization Device (PED; Medtronic) has been used off-label for the treatment of challenging posterior circulation aneurysms. Data on this modality are primarily limited to small retrospective single-center series. To assess safety and efficacy of this treatment by establishing an international, multicenter collaboration. Consecutive posterior circulation aneurysms treated with the PED from 2012 to 2019 across 11 neurovascular centers were retrospectively reviewed. Baseline demographics, aneurysm and treatment characteristics, complications, occlusion status, and functional outcome were assessed. There were 149 posterior circulation aneurysms treated with PED in 146 patients. A total of 24 (16.4%) patients presented with subarachnoid hemorrhage. Most aneurysms were dissecting/blister (36.2%) in morphology, followed by saccular (35.6%) and fusiform (28.2%). The most common locations were the vertebral (51.7%) and basilar arteries (22.8%). Complete or near-complete occlusion (>90%) was achieved in 90.9% of aneurysms at a median follow-up of 12 mo. Dissecting/blister aneurysms were most likely to occlude (P = .06). Symptomatic neurologic complications occurred in 9.4% of aneurysms, associated with larger size, ruptured presentation, presentations with brain stem compression, cranial nerve palsy, or stroke. Favorable functional outcome (modified Rankin Score 0-2) was achieved in 86.2% of patients. There were 6 fatalities of which 4 occurred in aneurysmal subarachnoid hemorrhage patients. This multicenter study shows that PED for the treatment of posterior circulation is preferentially used for the treatment of fusiform and dissecting/blister aneurysm morphologies. Despite the challenges presented by these less-common morphologies, flow diversion may be performed with a neurologic complication rate of about 10% and favorable long-term aneurysm occlusion rates.

Sections du résumé

BACKGROUND
The Pipeline Embolization Device (PED; Medtronic) has been used off-label for the treatment of challenging posterior circulation aneurysms. Data on this modality are primarily limited to small retrospective single-center series.
OBJECTIVE
To assess safety and efficacy of this treatment by establishing an international, multicenter collaboration.
METHODS
Consecutive posterior circulation aneurysms treated with the PED from 2012 to 2019 across 11 neurovascular centers were retrospectively reviewed. Baseline demographics, aneurysm and treatment characteristics, complications, occlusion status, and functional outcome were assessed.
RESULTS
There were 149 posterior circulation aneurysms treated with PED in 146 patients. A total of 24 (16.4%) patients presented with subarachnoid hemorrhage. Most aneurysms were dissecting/blister (36.2%) in morphology, followed by saccular (35.6%) and fusiform (28.2%). The most common locations were the vertebral (51.7%) and basilar arteries (22.8%). Complete or near-complete occlusion (>90%) was achieved in 90.9% of aneurysms at a median follow-up of 12 mo. Dissecting/blister aneurysms were most likely to occlude (P = .06). Symptomatic neurologic complications occurred in 9.4% of aneurysms, associated with larger size, ruptured presentation, presentations with brain stem compression, cranial nerve palsy, or stroke. Favorable functional outcome (modified Rankin Score 0-2) was achieved in 86.2% of patients. There were 6 fatalities of which 4 occurred in aneurysmal subarachnoid hemorrhage patients.
CONCLUSION
This multicenter study shows that PED for the treatment of posterior circulation is preferentially used for the treatment of fusiform and dissecting/blister aneurysm morphologies. Despite the challenges presented by these less-common morphologies, flow diversion may be performed with a neurologic complication rate of about 10% and favorable long-term aneurysm occlusion rates.

Identifiants

DOI: 10.1093/neuros/nyaa277 PMID: 32629474
pubmed: 32629474
pii: 5868083
doi: 10.1093/neuros/nyaa277
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

1252-1261

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2020 by the Congress of Neurological Surgeons.

Auteurs

Christoph J Griessenauer (CJ)

Department of Neurosurgery, Geisinger, Danville, Pennsylvania.
Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.

Alejandro Enriquez-Marulanda (A)

Boston Medical Center, Boston University, Boston, Massachusetts.

Philipp Taussky (P)

Department of Neurosurgery, University of Utah, Salt Lake City, Utah.

Arundhati Biswas (A)

Department of Neurosurgery, University of Utah, Salt Lake City, Utah.

Ramesh Grandhi (R)

Department of Neurosurgery, University of Utah, Salt Lake City, Utah.

Sissi Xiang (S)

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Tao Hong (T)

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Lorenzo Rinaldo (L)

Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.
ORCID: 0000-0002-7800-7726

Giuseppe Lanzino (G)

Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.

Waleed Brinjikji (W)

Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.

Jan-Karl Burkhardt (JK)

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.

Peter Kan (P)

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.

Mandeep Ghuman (M)

Departments of Medical Imaging & Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

Victor X D Yang (VXD)

Departments of Medical Imaging & Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

Karen Chen (K)

Departments of Radiology & Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.

Mohammad A Aziz-Sultan (MA)

Departments of Radiology & Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.

Mohammad Ghorbani (M)

Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.

Clemens M Schirmer (CM)

Department of Neurosurgery, Geisinger, Danville, Pennsylvania.
Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.

Oded Goren (O)

Department of Neurosurgery, Geisinger, Danville, Pennsylvania.

Shamsher S Dalal (SS)

Department of Radiology, Geisinger, Danville, Pennsylvania.

Monika Killer-Oberpfalzer (M)

Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.
Department of Neurology, Paracelsus Medical University, Salzburg, Austria.

Erasmia Müller-Thies-Broussalis (E)

Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.
Department of Neurology, Paracelsus Medical University, Salzburg, Austria.

Matthew J Koch (MJ)

Massachussetts General Hospital, Harvard University, Boston, Massachusetts.

Christopher J Stapleton (CJ)

Massachussetts General Hospital, Harvard University, Boston, Massachusetts.

Aman B Patel (AB)

Massachussetts General Hospital, Harvard University, Boston, Massachusetts.

Paul M Foreman (PM)

Neuroscience and Rehabilitation Institute, Orlando Health, Orlando, Florida.

Marshall C Cress (MC)

Neuroscience and Rehabilitation Institute, Orlando Health, Orlando, Florida.

Robert A Hirschl (RA)

Neuroscience and Rehabilitation Institute, Orlando Health, Orlando, Florida.

Timo Krings (T)

Division of Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.

Hongqi Zhang (H)

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.

Adam A Dmytriw (AA)

Departments of Medical Imaging & Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Division of Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.
ORCID: 0000-0003-0131-5699

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Experience With the Pipeline Embolization...
questionsmedicales.fr › Thérapeutique › Occlusion thérapeutique › Embolisation thérapeutique › Experience With the Pipeline Embolization...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › Experience With the Pipeline Embolization...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études de suivi › Experience With the Pipeline Embolization...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Experience With the Pipeline Embolization...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Artériopathies intracrâniennes › Anévrysme intracrânien › Experience With the Pipeline Embolization...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Experience With the Pipeline Embolization...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Experience With the Pipeline Embolization...