Multiple pipeline embolization devices improves aneurysm occlusion without increasing morbidity: A single center experience of 140 cases | JoVE Visualize

Multiple pipeline embolization devices improves aneurysm occlusion without increasing morbidity: A single center experience of 140 cases

Thomas W Link¹, Joseph A Carnevale¹, Jacob L Goldberg¹

¹Department of Neurosurgery, Weill Cornell Medical Institution New York Presbyterian Hospital, New York, NY, USA.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia|March 29, 2021

View abstract on PubMed

Summary

Using multiple pipeline embolization devices (PEDs) for intracranial aneurysms significantly increases occlusion rates without raising complication risks. This approach is especially beneficial for ophthalmic segment aneurysms, offering a safer treatment option.

Area of Science:

Neurosurgery
Interventional Radiology
Vascular Neurology

Background:

Aneurysm occlusion rates with pipeline embolization devices (PEDs) vary widely in existing literature (55.7%-93.3% at 6 months).
Technique variations, including device sizing and number used, may explain these discrepancies.

Purpose of the Study:

To compare the efficacy and safety of single versus multiple PEDs for treating intracranial aneurysms.
To identify factors influencing aneurysm occlusion rates and complications.

Main Methods:

Retrospective review of 140 intracranial aneurysm cases treated with PEDs at a single institution.
Comparison of aneurysm occlusion rates and complication profiles between patients treated with single PED versus multiple PEDs.

Main Results:

Overall complete aneurysm occlusion rates were 86.9% at 6 months, 91.8% at 1 year, and 97.6% at longest follow-up.
Patients treated with multiple PEDs demonstrated significantly higher occlusion rates at 6 months (92.9% vs. 75.6%) and 12 months (98.4% vs. 81.1%) compared to single PED treatment, with no significant difference in complication rates.
Multiple PED use was an independent predictor of aneurysm occlusion (p=0.015).

Conclusions:

The use of multiple PEDs for intracranial aneurysms leads to significantly higher occlusion rates without increased morbidity.
This strategy is particularly advantageous for ophthalmic segment aneurysms.
Caution is advised for treating distal segments with eloquent perforating branches using multiple PEDs.