From the Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA (N.C., R.M.S., S.Y., C.D.B., S.T., L.F.G., R.R., P.J.); and Department of Neurosurgery, University of Iowa, Iowa City, IA (D.H.).
Stroke. 2014 Jan;45(1):54-8. doi: 10.1161/STROKEAHA.113.003038. Epub 2013 Nov 19.
Flow diverters are currently indicated for treatment of large and complex intracranial aneurysms. The purpose of this study was to determine whether the indications of flow diversion can be safely extended to unruptured, small, saccular aneurysms (<10 mm) of the anterior circulation.
Forty patients treated with the pipeline embolization device (PED) were matched in a 1:4 fashion with 160 patients treated with stent-assisted coiling based on patient age, sex, aneurysm location, and aneurysm size. Procedural complications, angiographic results, and clinical outcomes were analyzed and compared.
The rate of periprocedural complications was 5% in the PED group and 3% in the stent-coil group (P=0.7). In multivariable analysis, increasing age was the only predictor of complications. At follow-up, a higher proportion of aneurysms treated with PED (80%) achieved complete obliteration compared with stent-coiled aneurysms (70%) but the difference did not reach statistical significance (P=0.2). In multivariable analysis, increasing aneurysm size and aneurysm location were predictors of nonocclusion. The rate of favorable outcome (modified Rankin Scale, 0-2 and modified Rankin Scale, 0-1) was similar in the PED group and the coil group.
The PED was associated with similar periprocedural risks, clinical outcomes, and angiographic results compared with stent-assisted coiling. These findings suggest that the indications of PED can be safely extended to small intracranial aneurysms that are amenable to conventional endovascular techniques. Larger studies with long-term follow-up are necessary to determine the optimal treatment that leads to the highest rate of obliteration and best clinical outcomes.
血流导向装置目前用于治疗大型和复杂颅内动脉瘤。本研究旨在确定血流导向装置的适应证是否可以安全地扩展到未破裂、小的、囊状的前循环动脉瘤(<10mm)。
将 40 例接受Pipeline 栓塞装置（PED）治疗的患者按照患者年龄、性别、动脉瘤位置和动脉瘤大小以 1:4 的比例与 160 例接受支架辅助弹簧圈治疗的患者进行匹配。分析比较了手术并发症、血管造影结果和临床结果。
PED 组的围手术期并发症发生率为 5%，支架-线圈组为 3%（P=0.7）。多变量分析显示，年龄增加是并发症的唯一预测因素。随访时，PED 治疗的动脉瘤（80%）完全闭塞的比例高于支架-线圈治疗的动脉瘤（70%），但差异无统计学意义（P=0.2）。多变量分析显示，动脉瘤大小和位置的增加是未闭塞的预测因素。PED 组和线圈组的良好预后（改良Rankin 量表 0-2 和改良Rankin 量表 0-1）率相似。
与支架辅助弹簧圈治疗相比，PED 具有相似的围手术期风险、临床结果和血管造影结果。这些发现表明，PED 的适应证可以安全地扩展到适合传统血管内技术的小型颅内动脉瘤。需要进行更大规模的长期随访研究，以确定导致闭塞率最高和最佳临床结果的最佳治疗方法。
