Treatment of intracranial aneurysms with pipeline embolization device: a single-center experience

Wenbao Liang; Jiaqi Yin; Chenyu Lu; Jianbo Yang; Xiaoqiang Ma; Xin Zhang; Mirzat Turhon; Xinling Yang

doi:10.21037/qims-23-1289

Treatment of intracranial aneurysms with pipeline embolization device: a single-center experience

Quant Imaging Med Surg. 2024 Apr 3;14(4):2916-2926. doi: 10.21037/qims-23-1289. Epub 2024 Mar 18.

Authors

Wenbao Liang^{1

2

3}, Jiaqi Yin⁴, Chenyu Lu³, Jianbo Yang², Xiaoqiang Ma³, Xin Zhang³, Mirzat Turhon^{5

6}, Xinling Yang^{1

7}

Affiliations

¹ Department of Neurology, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
² Department of Neurology, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China.
³ Department of Neurosurgery, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China.
⁴ Department of Cardiology three, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China.
⁵ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁶ Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
⁷ Department of Neurology, Xinjiang Medical University, Urumqi, China.

Abstract

Background: Endovascular therapy is the primary treatment modality for intracranial aneurysms (IA). The objective of this study was to assess the effectiveness and safety of a pipeline embolization device (PED) for the treatment of IA.

Methods: This retrospective study was conducted at a single center. Data were collected for all patients who underwent PED treatment at the Fourth Affiliated Hospital of Xinjiang Medical University between December 2018 and January 2022. Clinical characteristics, aneurysm-related characteristics, treatment details, and clinical and imaging outcomes were collected and analyzed.

Results: A total of 60 consecutive patients with 60 IAs were treated with a PED. The mean age of the participants was 61.8 years, with 53% being female. The average size of the aneurysms was 14.7 mm, with 54 located in the anterior circulation and six in the posterior circulation. The median last follow-up time was 13.0 months (range, 11-24 months). All patients underwent final digital subtraction angiography (DSA) for angiographic follow-up, and 50 aneurysms (83.3%) were completely occluded. The overall complication rate was 3.3%, and there were no reported mortalities. Among the 12 cases of ruptured aneurysms, all of which underwent adjunctive coil embolization, the complete occlusion rate was 91.7% with a complication rate of 16.6% [ischemic complication and modified Rankin scale (mRS) deteriorated]. In the 6 cases of posterior circulation aneurysms (2 in the basilar artery), 5 cases achieved complete occlusion and 1 case achieved near-complete occlusion, with no reported complications or mortality.

Conclusions: The use of PEDs appears to be an effective treatment option for IA, demonstrating high occlusion rates and low complication rates. While the application of PEDs for the treatment of ruptured aneurysms did not increase the risk of secondary aneurysm rupture, caution is still warranted due to a higher complication rate. In the treatment of aneurysms of the vertebrobasilar artery using PEDs, this study achieved favorable efficacy outcomes without complications nor patient mortality. However, further studies are needed to validate these findings.

Keywords: Endovascular recanalization; standard medical therapy; symptomatic non-acute intracranial artery occlusion.