Coiling embolization strategy for medium-to-giant-sized intracranial aneurysms treated with pipeline embolization device: a propensity score-weighted study.
Costs and cost analysis
Endovascular procedures
Intracranial aneurysm
Treatment outcome
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
22
10
2022
accepted:
01
05
2023
revised:
04
04
2023
medline:
27
10
2023
pubmed:
14
6
2023
entrez:
14
6
2023
Statut:
ppublish
Résumé
We aim to investigate associations between different coil strategies and outcomes in the aneurysms treated by a pipeline embolization device (PED). Patients with medium-to-giant-sized aneurysms treated by PED were included. The total cohort was divided into PED-alone and PED-coiling groups, and the PED-coiling group was further divided into loose and dense packing subgroups. Multivariate logistic analyses and stabilized inverse probability of treatment weighting (sIPTW) were performed to investigate the relationships between coiling strategies and outcomes. Restricted cubic spline (RCS) curves were used to describe the coiling degree and angiographic outcome relationship. A total of 398 patients with 410 aneurysms were included. Aneurysms treated with PED coiling had a lower incomplete occlusion rate (15.3% vs. 30.3%, p = 0.002), higher total perioperative complication rate (14.2% vs. 3.5%, p = 0.001), longer production time (142.14 min vs. 101.26 min, p < 0.001), and higher total cost ($45,158.63 vs. $34,680.91, p < 0.001) than those treated with PED alone. There were no differences in outcomes between the loose and dense packing subgroups. However, the total cost was higher in the dense packing group ($43,787.46 vs. $47,288.32, p = 0.001) than in the loose packing group. The result was still robust in the multivariate and sIPTW analyses. The RCS curves showed "L-shape" relationships between the coil degree and angiographic outcomes. Compared with PED alone, PED coiling could improve aneurysm occlusion. However, it could also increase the total complication risk, prolong procedure time, and increase the total cost. Compared with loose packing, dense packing did not enhance the treatment effectiveness but increased the treatment cost. The additional treatment effect from coiling embolization declines sharply after a certain point. Specifically, the aneurysm occlusion rate is roughly stable when the coil number is greater than 3 or the total coil length is longer than 150 cm. • Compared with pipeline embolization device (PED) alone, PED combined with coiling can improve aneurysm occlusion. • Compared with PED alone, PED combined with coiling increases the total complication risk, cost, and prolongs procedure time. • Compared with loose packing, dense packing did not increase the treatment effectiveness but increased the cost.
Identifiants
pubmed: 37314476
doi: 10.1007/s00330-023-09800-z
pii: 10.1007/s00330-023-09800-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7967-7977Subventions
Organisme : Natural Science Foundation of China
ID : 81771233
Organisme : Natural Science Foundation of China
ID : 82171290
Organisme : Research and Promotion Program of Appropriate Techniques for Intervention of Chinese High-risk Stroke People
ID : GN-2020R0007
Organisme : BTH Coordinated Development-Beijing Science and Technology Planning Project
ID : Z181100009618035
Organisme : Beijing Municipal Administration of Hospitals' Ascent Plan
ID : DFL20190501
Organisme : Beijing Natural Science Foundation
ID : 19L2013
Organisme : Beijing Natural Science Foundation
ID : 22G10396
Informations de copyright
© 2023. The Author(s), under exclusive licence to European Society of Radiology.
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