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Clinical and angiographic outcomes in patients with intracranial aneurysms treated with the pipeline embolization device: intra-procedural technical difficulties, major morbidity, and neurological mortality decrease significantly with increased operator experience in device deployment and patient management

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

Flow diversion constitutes a pivotal advancement in endovascular intracranial aneurysm treatment, but requires development of a new skill set. The aim of this study is to determine whether outcomes after treatment with the Pipeline Embolization Device improve with experience.

Methods

We retrospectively reviewed all patients with intracranial aneurysms treated with Pipeline at two centers over a 4.5-year period. Baseline patient and aneurysm characteristics, complications, and angiographic outcomes were analyzed.

Results

One hundred forty patients underwent 150 Pipeline procedures to treat 167 intracranial aneurysms during the study period, 109 women, mean age 55.4 years. One hundred twenty-six aneurysms were ICA, mean size 10.2 mm and mean neck 6.4 mm. Intra-procedural technical difficulties were higher during the first 75 procedures compared with the subsequent 75 (13.3 vs 2.7%; p = 0.03), as combined major morbidity and neurological mortality (14.7 vs 4%; p = 0.046). In multivariate regression analysis, increased operator experience with Pipeline remained an independent predictor of intra-procedural technical difficulties (p = 0.02, odds ratio (OR) 0.015, 95% CI 0.0004–0.55) and combined major morbidity and neurological mortality (p = 0.03, OR 0.16, 95% CI 0.03–0.84). At last follow-up, 123 aneurysms were completely occluded (81.5%, mean 24 months). In our cohort, age ≤ 53 years was an independent predictor of complete aneurysm occlusion at last follow-up (p = 0.001, OR 0.92, 95% CI 0.88–0.97). Five aneurysms were retreated (3.3%).

Conclusion

The Pipeline embolization device is an effective treatment for intracranial aneurysms. The risk of intra-procedural technical difficulties and combined major morbidity and neurological mortality decreases significantly with increased operator experience in Pipeline deployment and patient management.

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Acknowledgments

The authors would like to acknowledge Sandee K. Verootis, Radiology Department, Abbott Northwestern Hospital, for her contribution in the data collection for this study.

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Authors and Affiliations

  1. Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, 800 E. 28th Street, Minneapolis, MN, 55407, USA

    Josser E. Delgado Almandoz, Yasha Kayan, Adam N. Wallace, Jill M. Scholz, Jennifer L. Fease & Anna M. Milner

  2. Division of Interventional Neuroradiology, Clínica El Ávila, Caracas, Venezuela

    Andrea Tenreiro & Oscar Tenreiro-Picón

  3. Division of Critical Care Medicine, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA

    Maximilian Mulder

  4. Division of Neurological Surgery, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA

    Kyle M. Uittenbogaard

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  1. Josser E. Delgado Almandoz
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  2. Yasha Kayan
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Corresponding author

Correspondence to Josser E. Delgado Almandoz.

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Funding

No funding was received for this study.

Conflict of interest

JEDA and YK are proctors for the Pipeline Embolization Device.

Ethics approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of Abbott Northwestern Hospital and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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For this type of retrospective study formal consent is not required.

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Delgado Almandoz, J.E., Kayan, Y., Tenreiro, A. et al. Clinical and angiographic outcomes in patients with intracranial aneurysms treated with the pipeline embolization device: intra-procedural technical difficulties, major morbidity, and neurological mortality decrease significantly with increased operator experience in device deployment and patient management. Neuroradiology 59, 1291–1299 (2017). https://doi.org/10.1007/s00234-017-1930-z

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  • DOI: https://doi.org/10.1007/s00234-017-1930-z

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