Predictors of Incomplete Occlusion following Pipeline Embolization of Intracranial Aneurysms: Is It Less Effective in Older Patients?

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FIGURE.
Age-related variation in the rate of complete occlusion following intracranial aneurysm treatment with PEDs.

Table 1:

Baseline characteristics

Parameter	No.
No. of procedures	329
No. of aneurysms	380
Sex
Female	272 (82.7%)
Male	57 (17.3%)
Median age (range) (yr)	58 (18–82)
Smoking	85 (25.8%)
Multiple aneurysms	148 (45%)
Pretreatment mRS
0–2	314 (95.4%)
3–5	15 (4.6%)
Aneurysm location
ICA
Petrous	7 (1.8%)
Cavernous	63 (16.6%)
Paraophthalmic	212 (55.8%)
PcomA	34 (9%)
ACA/AcomA	5 (1.3%)
MCA	8 (2.1%)
Posterior circulation	51 (13.4%)
Aneurysm shape
Saccular	257 (67.6%)
Blister	11 (2.9%)
Fusiform	102 (26.9%)
Dissecting	10 (2.6%)
Aneurysm measurements (median) (range) (mm)
Maximal diameter^{^a}	7.7 (1–44.5)
Neck size (for saccular aneurysms)^{^b}	4 (1–15.6)
Dome-to-neck ratio (for saccular aneurysms)^{^b}	1.3 (0.4–3.5)
Daughter sac	94 (24.7%)
Subarachnoid hemorrhage
Acute (<2 wk)	10 (3%)
Remote (>2 wk)	32 (9.7%)
Prior treatment
Endovascular	33 (8.7%)
Operation	6 (1.6%)
Both	4 (1.1%)

Note:—ACA indicates anterior cerebral artery; PcomA, posterior communicating artery; AcomA, anterior communicating artery.
↵a Data are missing for 11 aneurysms.
↵b Data are missing for 41 aneurysms.

Table 2:

Outcome measures

Parameter	No.
No. of Pipelines
1	255 (77.5%)
2	52 (15.8%)
≥3	22 (6.7%)
Platelet function test
Yes	316 (96%)
No	13 (4%)
Clopidogrel responder
Yes	228 (72.2%)
No	88 (27.8%)
Nonresponders' treatment
Switch to ticagrelor	27 (30.7%)
Clopidogrel boost	39 (44.3%)
Same dose of clopidogrel	22 (25%)
Last angiographic follow-up (median) (range) (mo)	13.5 (1–83)
Follow-up occlusion rate
Complete (100%)	297 (78.2%)
Near-complete (90%–99%)	29 (7.6%)
Partial (<90%)	54 (14.2%)
Retreatment
Endovascular	24 (6.3%)
Posttreatment mRS
0–2	314 (95.6%)
3–5	11 (3.3%)
6 (Death)	4 (1.2%)
Follow-up mRS
Improved	110 (33.4%)
No change	190 (57.8%)
Worsened	29 (8.8%)
Neurologic complications
Thromboembolic	31 (9.4%)
Symptomatic	17 (5.2%)
Hemorrhagic	11 (3.3%)
Symptomatic	6 (1.8%)

Table 3:

Multivariable logistic regression for predictors of incomplete occlusion at last follow-up

Parameter	OR	95% CI	P Value
Age (older than 70 yr)	2.0	1.1–3.8	.03
Nonsmokers	2.0	1.1–3.9	.03
PcomA/posterior circulation	1.6	0.9–2.9	.13
Maximal diameter (≥21 mm)	2.1	0.9–4.7	.08
Length of follow-up (<12 months)	2.1	1.2–3.5	.007