Abstract Details

Title Treatment of Intracranial Aneurysms with Pipeline Embolization Device: A Systematic Review of Literature

Topic Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 087

Objective

Background BACKGROUND: PED is a flow-diverter used in the endovascular treatment of intracranial aneurysms, particularly those with unfavorable configurations like giant, wide-necked, or fusiform aneurysms. It causes progressive flow redirection leading to aneurysm thrombosis. We present a systematic review of published literature on the clinical outcomes of PED.

Design/Methods DESIGN/METHODS: A Medline search of English language literature was performed using the keywords "intracranial aneurysms" and "pipeline embolization device" or "flow diverters". The search returned 53 articles. The inclusion criteria were N>10 patients, aneurysms treated with PEDs only, clear documentation of complications.

Results RESULTS: A total of 13 studies met the inclusion criteria. 796 patients with 906 aneurysms had treatment with PED. The mean age was 53.8 years, with 75% (95% CI 72.5-78.5%) women. Mean aneurysm diameter was 13.1 mm. Based on size, 45% of aneurysms were small, 42.9% were large, and 12% were giant. 92.3% (95% CI 90.2-94.4%) aneurysms had a dome:neck ratio < 1.5-2. Cumulative mortality rate was 2.4% (95% CI 1.3-3.5%). The periprocedural complication rate varied from 2-22%, while the delayed complication rate was 0-13%. 11 patients had stroke (1.4%), while 17 (2.1%,) had TIA and 13 patients (1.6%) had intracerebral hemorrhage. The main outcome measure was aneurysm occlusion rate at 6 months. Out of 585 aneurysms with follow-up information, 500 had near-to complete occlusion (85.5%, 95% CI 82.7-88.4%). Funnel plot with study size plotted against outcome measure revealed publication bias.

Conclusions CONCLUSIONS: With increasing operator experience, PEDs are more widely being used for embolization of aneurysms. While there is no head to head comparison of PEDs with contemporary endovascular treatments, data from recent trials suggest that there may be a lower complication rate and mortality associated with PED. More trials are warranted to validate these results.

Authors/Disclosures
Santosh B. Murthy, MD (Weill Cornell Medicine) PRESENTER	Dr. Murthy has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for CarePoint. Dr. Murthy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alnylam. Dr. Murthy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Stroke and Neurological disorders. The institution of Dr. Murthy has received research support from National Institutes of Health/NINDS.
Shreyansh Shah, MD (Massachusetts General Hospital, Brigham, Harvard)	No disclosure on file
Chethan P. Venkatasubba Rao, MD (Baylor College of Medicine)	Dr. Venkatasubba Rao has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Maestro Inc.
Eric Bershad, MD (Baylor College of Medicine)	Dr. Bershad has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various.
Jose I. Suarez, MD, FAAN (Johns Hopkins Hospital)	Dr. Suarez has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Idorsia. Dr. Suarez has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for The Mayo Clinic.
Timothy Cunniff, PharmD	Dr. Cunniff has received personal compensation for serving as an employee of Paragon Biosciences. Dr. Cunniff has stock in Harmony Biosciences. Dr. Cunniff has stock in Emalex Biosciences.

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