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Research ArticleNeurointervention

Long-Term Follow-Up Results following Elective Treatment of Unruptured Intracranial Aneurysms with the Pipeline Embolization Device

A.H.Y. Chiu, A.K. Cheung, J.D. Wenderoth, L. De Villiers, H. Rice, C.C. Phatouros, T.P. Singh, T.J. Phillips and W. McAuliffe
American Journal of Neuroradiology September 2015, 36 (9) 1728-1734; DOI: https://doi.org/10.3174/ajnr.A4329
A.H.Y. Chiu
aFrom the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia
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A.K. Cheung
aFrom the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia
bPrince of Wales and Liverpool Hospitals (A.K.C., J.D.W.), Sydney, Australia
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J.D. Wenderoth
bPrince of Wales and Liverpool Hospitals (A.K.C., J.D.W.), Sydney, Australia
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L. De Villiers
cGold Coast University Hospital (L.D.V., H.R.), Gold Coast, Australia.
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H. Rice
cGold Coast University Hospital (L.D.V., H.R.), Gold Coast, Australia.
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C.C. Phatouros
aFrom the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia
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T.P. Singh
aFrom the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia
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T.J. Phillips
aFrom the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia
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W. McAuliffe
aFrom the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia
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Abstract

BACKGROUND AND PURPOSE: Numerous reports of treatment of wide-neck aneurysms by flow diverters have been published; however, long-term outcomes remain uncertain. This article reports the imaging results of unruptured aneurysms treated electively with the Pipeline Embolization Device for up to 56 months and clinical results for up to 61 months.

MATERIALS AND METHODS: One hundred nineteen aneurysms in 98 patients from 3 centers admitted between August 2009 and June 2011 were followed at 6-month, 1-year, and 2+-year postprocedural timeframes. Analyses on the effects of incorporated vessels, previous stent placement, aneurysm size, and morphology on aneurysm occlusion were performed.

RESULTS: The 1- and 2+-year imaging follow-ups were performed, on average, 13 and 28 months postprocedure. At 2+-year follow-up, clinical data were 100% complete and imaging data were complete for 103/116 aneurysms (88.8%) with a 93.2% occlusion rate. From 0 to 6 months, TIA, minor stroke, and major stroke rates were 4.2%, 3.4%, and 0.8% respectively. After 6 months, 1 patient had a TIA of uncertain cause, with an overall Pipeline Embolization Device–related mortality rate of 0.8%. An incorporated vessel was significant for a delay in occlusion (P = .009) and nonocclusion at 6 months and 1 year, with a delayed mean time of occlusion from 9.1 months (95% CI, 7.1–11.1 months) to 16.7 months (95% CI, 11.4–22.0 months). Other factors were nonsignificant.

CONCLUSIONS: The Pipeline Embolization Device demonstrates continued very high closure rates at 2+ years, with few delayed clinical adverse sequelae. The presence of an incorporated vessel in the wall of the aneurysm causes a delay in occlusion that approaches sidewall closure rates by 2 years.

ABBREVIATIONS:

DAT
dual antiplatelet therapy
PED
Pipeline Embolization Device
  • © 2015 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 36 (9)
American Journal of Neuroradiology
Vol. 36, Issue 9
1 Sep 2015
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A.H.Y. Chiu, A.K. Cheung, J.D. Wenderoth, L. De Villiers, H. Rice, C.C. Phatouros, T.P. Singh, T.J. Phillips, W. McAuliffe
Long-Term Follow-Up Results following Elective Treatment of Unruptured Intracranial Aneurysms with the Pipeline Embolization Device
American Journal of Neuroradiology Sep 2015, 36 (9) 1728-1734; DOI: 10.3174/ajnr.A4329

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Long-Term Follow-Up Results following Elective Treatment of Unruptured Intracranial Aneurysms with the Pipeline Embolization Device
A.H.Y. Chiu, A.K. Cheung, J.D. Wenderoth, L. De Villiers, H. Rice, C.C. Phatouros, T.P. Singh, T.J. Phillips, W. McAuliffe
American Journal of Neuroradiology Sep 2015, 36 (9) 1728-1734; DOI: 10.3174/ajnr.A4329
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  • Brain aneurysm and parent vessel remodeling after flow diversion treatment: a proposed modification for Cekirge-Saatci classification (mCSC)
  • Predictors of incomplete aneurysm occlusion after treatment with the Pipeline Embolization Device: PREMIER trial 1 year analysis
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  • Outcome of Flow Diverters with Surface Modifications in Treatment of Cerebral Aneurysms: Systematic Review and Meta-analysis
  • Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis
  • Pipeline embolization device diameter is an important factor determining the efficacy of flow diversion treatment of small intracranial saccular aneurysms
  • Antiplatelet therapy and the risk of ischemic and hemorrhagic complications associated with Pipeline embolization of cerebral aneurysms: a systematic review and pooled analysis
  • Safety and efficacy of the Derivo Embolization Device for the treatment of unruptured intracranial aneurysms: a multicentric study
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  • Pipeline Diameter Significantly Impacts the Long-Term Fate of Jailed Side Branches during Treatment of Intracranial Aneurysms
  • Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter: A Multicenter, Randomized, Controlled Clinical Trial (PARAT)
  • Single-stage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques: is it safe to treat all at once?
  • An outcomes-based grading scale for the evaluation of cerebral aneurysms treated with flow diversion
  • Early angiographic signs of acute thrombus formation following cerebral aneurysm treatment with the Pipeline embolization device
  • Endovascular flow diversion for treatment of anterior communicating artery region cerebral aneurysms: a single-center cohort of 50 cases
  • Republished: Rapid delayed growth of ruptured supraclinoid blister aneurysm after successful flow diverting stent treatment
  • FRED Flow Diverter: A Study on Safety and Efficacy in a Consecutive Group of 50 Patients
  • Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 Flow Modulation Device: a multicenter experience
  • Republished: Pipeline embolization device induced collateral channels in elective flow diversion treatment
  • Republished: Pipeline embolization device thrombosis induced peri-construct collateral channels
  • Rapid delayed growth of ruptured supraclinoid blister aneurysm after successful flow diverting stent treatment
  • Current Trends and Results of Endovascular Treatment of Unruptured Intracranial Aneurysms at a Single Institution in the Flow-Diverter Era
  • Imaging Follow-Up of Intracranial Aneurysms Treated by Endovascular Means: Why, When, and How?
  • Pipeline embolization device induced collateral channels in elective flow diversion treatment
  • Pipeline embolization device thrombosis induced peri-construct collateral channels
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