Declining complication rates with flow diversion of anterior circulation aneurysms after introduction of the Pipeline Flex: analysis of a single-institution series of 568 cases

• Published in: Journal of neurosurgery Vol. 129; no. 6; p. 1475
• Main Authors: Colby, Geoffrey P, Bender, Matthew T, Lin, Li-Mei, Beaty, Narlin, Caplan, Justin M, Jiang, Bowen, Westbroek, Erick M, Varjavand, Bijan, Campos, Jessica K, Huang, Judy, Tamargo, Rafael J, Coon, Alexander L
• Format: Journal Article
• Language: English
• Published: United States 01.12.2018
• Subjects: Adult; Aged; Aged, 80 and over; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - instrumentation; Female; Humans; Incidence; Intracranial Aneurysm - therapy; Male; Middle Aged; Postoperative Complications - epidemiology; Prospective Studies; Retrospective Studies; Treatment Outcome; Young Adult; ACA = anterior cerebral artery; PRU = P2Y12 reaction units; SAH = subarachnoid hemorrhage; TIA = transient ischemic attack; cerebral aneurysm; MCA = middle cerebral artery; PUFS = Pipeline for Uncoilable or Failed Aneurysms; ICA = internal carotid artery; vascular disorders; flow diversion; ICH = intracranial hemorrhage; IntrePED = International Retrospective Study of the Pipeline Embolization Device; Cat5 = AXS Catalyst 5; PED = Pipeline embolization device; Pipeline embolization
• ISSN: 1933-0693
• DOI: 10.3171/2017.7.JNS171289

OBJECTIVEThe second-generation Pipeline embolization device (PED), Flex, has several design upgrades, including improved opening and the ability to be resheathed, in comparison with the original device (PED classic). The authors hypothesized that Flex is associated with a lower rate of major complications.METHODSA prospective, IRB-approved, single-institution database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion. The PED classic was used from August 2011 to January 2015, and the Pipeline Flex has been used since February 2015.RESULTSA total of 568 PED procedures (252 classic and 316 Flex) were performed for anterior circulation aneurysms. The average aneurysm size was 6.8 mm. Patients undergoing treatment with the Flex device had smaller aneurysms (p = 0.006) and were more likely to have undergone previous treatments (p = 0.001). Most aneurysms originated along the internal carotid artery (89% classic and 75% Flex) but there were more anterior cerebral artery (18%) and middle cerebral artery (7%) deployments with Flex (p = 0.001). Procedural success was achieved in 96% of classic and 98% of Flex cases (p = 0.078). Major morbidity or death occurred in 3.5% of cases overall: 5.6% of classic cases, and 1.9% of Flex cases (p = 0.019). On multivariate logistic regression, predictors of major complications were in situ thrombosis (OR 4.3, p = 0.006), classic as opposed to Flex device (OR 3.7, p = 0.008), and device deployment in the anterior cerebral artery or middle cerebral artery as opposed to the internal carotid artery (OR 3.5, p = 0.034).CONCLUSIONSFlow diversion of anterior circulation cerebral aneurysms is associated with an overall low rate of major complications. The complication rate is significantly lower since the introduction of the second-generation PED (Flex).