Chalouhi Nohra, Polifka Adam, Daou Badih, Kung David, Barros Guilherme, Tjoumakaris Stavropula, Gonzalez L Fernando, Starke Robert M, Hasan David, Judy Brendan, Rosenwasser Robert H, Jabbour Pascal
*Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; ‡Department of Neurosurgery, University of Iowa, Iowa City, Iowa.
Neurosurgery. 2015 Dec;77(6):875-9; discussion 879. doi: 10.1227/NEU.0000000000000908.
The Pipeline Embolization Device is a widely utilized flow diverter in the treatment of intracranial aneurysms.
To assess the incidence, clinical significance, predictors, and outcomes of in-Pipeline stenosis (IPS).
Angiographic studies in 139 patients treated between 2011 and 2013 were independently reviewed by 2 authors for the presence of IPS. Multivariable logistic regression analysis was conducted to determine predictors of IPS.
A total of 21 (15.8%) patients demonstrated some degree of IPS during the follow-up period at a mean time point of 6.7 months (range, 3-24 months). The stenosis was mild (<50%) in 11 patients, moderate (50%-75%) in 5, and severe (>75%) in 6. None were symptomatic or required further intervention. Sixteen of these 22 patients (73%) had IPS detected within 6 months. IPS was noted in 7.6% (1/13) of patients with posterior circulation aneurysms vs 16.7% (21/126) of those with anterior circulation aneurysms (P = .03). The rate of IPS was 60% (3/5) in patients who did not receive aspirin vs only 14.2% (19/134) in those who received aspirin (P = .02). In multivariable analysis, no aspirin therapy (odds ratio, 10.0; 95% confidence interval, 1.4-67.7; P = .02) and internal carotid artery aneurysm location (odds ratio, 3.1; 95% confidence interval, 1.1-8.8; P = .03) were strong independent predictors of IPS.
IPS is a common, early, and mostly benign complication. Patients with internal carotid artery aneurysms are more likely to develop IPS. Aspirin plays a key role in preventing IPS. The results of this study further support the safety of flow diverters.
IPS, in-Pipeline stenosisPED, Pipeline Embolization Device.
Pipeline栓塞装置是颅内动脉瘤治疗中广泛应用的血流导向装置。
评估Pipeline内狭窄（IPS）的发生率、临床意义、预测因素及预后。
由两名作者独立回顾2011年至2013年期间接受治疗的139例患者的血管造影研究，以确定是否存在IPS。进行多变量逻辑回归分析以确定IPS的预测因素。
共有21例（15.8%）患者在随访期间出现一定程度的IPS，平均时间点为6.7个月（范围3 - 24个月）。11例患者狭窄程度为轻度（<50%），5例为中度（50% - 75%），6例为重度（>75%）。均无症状，也无需进一步干预。这22例患者中有16例（73%）在6个月内检测到IPS。后循环动脉瘤患者中IPS发生率为7.6%（1/13），前循环动脉瘤患者中为16.7%（21/126）（P = 0.03）。未接受阿司匹林治疗的患者IPS发生率为60%（3/5），而接受阿司匹林治疗的患者仅为14.2%（19/134）（P = 0.02）。多变量分析显示，未进行阿司匹林治疗（比值比，10.0；95%置信区间，1.4 - 67.7；P = 0.02）和颈内动脉动脉瘤位置（比值比，3.1；95%置信区间，1.1 - 8.8；P = 0.03）是IPS的强有力独立预测因素。
IPS是一种常见、早期且大多为良性的并发症。颈内动脉动脉瘤患者更易发生IPS。阿司匹林在预防IPS中起关键作用。本研究结果进一步支持了血流导向装置的安全性。
IPS，Pipeline内狭窄；PED，Pipeline栓塞装置
