Griessenauer Christoph J, Enriquez-Marulanda Alejandro, Taussky Philipp, Biswas Arundhati, Grandhi Ramesh, Xiang Sissi, Hong Tao, Rinaldo Lorenzo, Lanzino Giuseppe, Brinjikji Waleed, Burkhardt Jan-Karl, Kan Peter, Ghuman Mandeep, Yang Victor X D, Chen Karen, Aziz-Sultan Mohammad A, Ghorbani Mohammad, Schirmer Clemens M, Goren Oded, Dalal Shamsher S, Killer-Oberpfalzer Monika, Müller-Thies-Broussalis Erasmia, Koch Matthew J, Stapleton Christopher J, Patel Aman B, Foreman Paul M, Cress Marshall C, Hirschl Robert A, Krings Timo, Zhang Hongqi, Dmytriw Adam A
Department of Neurosurgery, Geisinger, Danville, Pennsylvania.
Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.
Neurosurgery. 2020 Nov 16;87(6):1252-1261. doi: 10.1093/neuros/nyaa277.
The Pipeline Embolization Device (PED; Medtronic) has been used off-label for the treatment of challenging posterior circulation aneurysms. Data on this modality are primarily limited to small retrospective single-center series.
To assess safety and efficacy of this treatment by establishing an international, multicenter collaboration.
Consecutive posterior circulation aneurysms treated with the PED from 2012 to 2019 across 11 neurovascular centers were retrospectively reviewed. Baseline demographics, aneurysm and treatment characteristics, complications, occlusion status, and functional outcome were assessed.
There were 149 posterior circulation aneurysms treated with PED in 146 patients. A total of 24 (16.4%) patients presented with subarachnoid hemorrhage. Most aneurysms were dissecting/blister (36.2%) in morphology, followed by saccular (35.6%) and fusiform (28.2%). The most common locations were the vertebral (51.7%) and basilar arteries (22.8%). Complete or near-complete occlusion (>90%) was achieved in 90.9% of aneurysms at a median follow-up of 12 mo. Dissecting/blister aneurysms were most likely to occlude (P = .06). Symptomatic neurologic complications occurred in 9.4% of aneurysms, associated with larger size, ruptured presentation, presentations with brain stem compression, cranial nerve palsy, or stroke. Favorable functional outcome (modified Rankin Score 0-2) was achieved in 86.2% of patients. There were 6 fatalities of which 4 occurred in aneurysmal subarachnoid hemorrhage patients.
This multicenter study shows that PED for the treatment of posterior circulation is preferentially used for the treatment of fusiform and dissecting/blister aneurysm morphologies. Despite the challenges presented by these less-common morphologies, flow diversion may be performed with a neurologic complication rate of about 10% and favorable long-term aneurysm occlusion rates.
管道栓塞装置（PED；美敦力公司）已被用于非标签治疗具有挑战性的后循环动脉瘤。关于这种治疗方式的数据主要限于小型回顾性单中心系列研究。
通过建立国际多中心合作来评估这种治疗方法的安全性和有效性。
对2012年至2019年期间在11个神经血管中心接受PED治疗的连续性后循环动脉瘤进行回顾性分析。评估基线人口统计学、动脉瘤和治疗特征、并发症、闭塞状态及功能结局。
146例患者共149个后循环动脉瘤接受了PED治疗。共有24例（16.4%）患者出现蛛网膜下腔出血。大多数动脉瘤形态为夹层/水泡状（36.2%），其次为囊状（35.6%）和梭形（28.2%）。最常见的部位是椎动脉（51.7%）和基底动脉（22.8%）。在中位随访12个月时，90.9%的动脉瘤实现了完全或接近完全闭塞（>90%）。夹层/水泡状动脉瘤最易闭塞（P = 0.06）。9.4%的动脉瘤出现有症状的神经并发症，与动脉瘤较大、破裂表现、伴有脑干压迫、颅神经麻痹或卒中的表现相关。86.2%的患者获得了良好的功能结局（改良Rankin评分0 - 2分）。有6例死亡，其中4例发生在动脉瘤性蛛网膜下腔出血患者中。
这项多中心研究表明，用于治疗后循环的PED优先用于治疗梭形和夹层/水泡状动脉瘤形态。尽管这些不太常见的形态带来了挑战，但血流导向治疗的神经并发症发生率约为10%，且长期动脉瘤闭塞率良好。
