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Safety and efficacy of the pipeline embolization device for treatment of small vs. large aneurysms: a systematic review and meta-analysis

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Abstract

Flow diversion with the pipeline embolization device (PED) is increasingly used to treat intracranial aneurysms with high obliteration rates and low morbidity. However, long-term (≥ 1 year) angiographic and clinical outcomes still require further investigation. The aim of this study was to compare the occlusion and complication rates for small (< 10 mm) versus large (10–25 mm) aneurysms at long-term following treatment with PED. A systematic review and meta-analysis were performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We conducted a comprehensive search of English language databases including Ovid MEDLINE and Epub Ahead of Print, In-Process, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Our studies included a minimum of 10 patients treated with PED for small vs. large aneurysms and with at least 12 months of follow-up. The primary safety endpoint was the rate of clinical complications measured by the occurrence of symptomatic stroke (confirmed clinically and radiographically), intracranial hemorrhage, or aneurysmal rupture. The primary efficacy endpoint was the complete aneurysm occlusion rate. Our analysis included 19 studies with 1277 patients and 1493 aneurysms. Of those, 1378 aneurysms met our inclusion criteria. The mean age was 53.9 years, and most aneurysms were small (89.75%; N = 1340) in women (79.1%; N = 1010). The long-term occlusion rate was 73% (95%, CI 65 to 80%) in small compared to 84% (95%, CI 76 to 90%) in large aneurysms (p < 0.01). The symptomatic thromboembolic complication rate was 5% (95%, CI 3 to 9%) in small compared to 7% (95%, CI 4 to 13%) in large aneurysms (p = 0.01). The rupture rate was 2% vs. 4% (p = 0.92), and the rate of intracranial hemorrhage was 2% vs. 4% (p = 0.96) for small vs. large aneurysms, respectively; however, these differences were not statistically significant. The long-term occlusion rate after PED treatment is higher in large vs. small aneurysms. Symptomatic thromboembolic rates with stroke are also higher in large vs. small aneurysms. The difference in the rates of aneurysm rupture and intracranial hemorrhage was insignificant. Although the PED seems a safe and effective treatment for small and large aneurysms, further studies are required to clarify how occlusion rate and morbidity are affected by aneurysm size.

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The datasets used originate from peer-reviewed publications available online.

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Author information

Authors and Affiliations

  1. Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA

    Abdul Karim Ghaith, Victor Gabriel El-Hajj, Marc Ghanem & Mohamad Bydon

  2. Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA

    Abdul Karim Ghaith, Victor Gabriel El-Hajj & Mohamad Bydon

  3. Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA

    Elena Greco, Jorge Rios-Zermeno, Carlos Perez-Vega, Samir Kashyap, W. Christopher Fox, Thien J. Huynh, Sukhwinder S. Sandhu & Rabih G. Tawk

  4. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

    Victor Gabriel El-Hajj, Marcus Ohlsson & Adrian Elmi-Terander

  5. Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, USA

    Bernard R. Bendok

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  1. Abdul Karim Ghaith
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Contributions

AKG: conception and design of the study, data collection, analysis, statistics, manuscript writing, critical manuscript review.

EG, JRZ, VGE, CPV, MG, SK: data collection, analysis, and interpretation, manuscript writing, critical manuscript review.

WCF, TJH, SSS, MO, AET, BRB, MB, RGT: conception and design of the study, critical manuscript review, and supervision of the work.

Corresponding author

Correspondence to Rabih G. Tawk.

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The need for ethical approval has been waved due to the de-identified nature of the data provided by the NIS database, as per the Mayo IRB.

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Ghaith, A.K., Greco, E., Rios-Zermeno, J. et al. Safety and efficacy of the pipeline embolization device for treatment of small vs. large aneurysms: a systematic review and meta-analysis. Neurosurg Rev 46, 284 (2023). https://doi.org/10.1007/s10143-023-02192-0

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