Zaeske Charlotte, Goertz Lukas, Dorn Franziska, Turowski Bernd, Abdullayev Nuran, Schlamann Marc, Liebig Thomas, Kabbasch Christoph
Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
World Neurosurg. 2021 Jan;145:e326-e331. doi: 10.1016/j.wneu.2020.10.062. Epub 2020 Oct 17.
Flow diversion represents a safe and efficient technique for the endovascular treatment of complex intracranial aneurysms. This study compares 2 competing flow diverters, the Pipeline embolization device (PED) and the Derivo Embolization Device (DED) regarding technical aspects, clinical outcome, and angiographic results.
A total of 111 patients with unruptured aneurysms were treated with the PED (n = 62) or the DED (n = 49) between 2011 and 2019. Procedural specifics, complication rates, functional outcome, and aneurysm occlusion were evaluated retrospectively.
Flow-diverter implantation was technically successful in all patients. There were no significant differences regarding baseline characteristics, adjunctive coiling, and fluoroscopy time. Multiple devices were more often used in the PED group (35.6%) than in the DED group (4.1%, P < 0.001). Procedural adverse events occurred in 4 cases of each group (PED: 5.5%, DED: 8.2%, P = 0.713), including 3 thromboembolic events and 1 hemorrhagic event per group. Morbidity rates were similar between the 2 groups (PED: 2.7%, DED: 4.1%, P = 1.0). There was no procedural mortality. At 6-month follow-up, complete or near-complete occlusion (O'Kelly-Marotta scale C+D) was achieved in 79.0% (49/62) after PED implantation and 80.0% (32/40) after DED implantation (P = 0.354).
In regard to complication rates, functional outcome, and aneurysm occlusion, no significant differences were found between the PED and DED collective.
血流导向是一种用于复杂颅内动脉瘤血管内治疗的安全有效的技术。本研究比较了两种相互竞争的血流导向装置,即Pipeline栓塞装置(PED)和Derivo栓塞装置(DED)在技术方面、临床结果和血管造影结果。
2011年至2019年间,共有111例未破裂动脉瘤患者接受了PED(n = 62)或DED(n = 49)治疗。对手术细节、并发症发生率、功能结果和动脉瘤闭塞情况进行了回顾性评估。
所有患者的血流导向装置植入在技术上均获成功。在基线特征、辅助弹簧圈栓塞和透视时间方面无显著差异。PED组(35.6%)比DED组(4.1%)更常使用多个装置(P < 0.001)。每组各有4例发生手术不良事件(PED:5.5%,DED:8.2%,P = 0.713),每组包括3例血栓栓塞事件和1例出血事件。两组的发病率相似(PED:2.7%,DED:4.1%,P = 1.0)。无手术死亡病例。在6个月的随访中,PED植入后79.0%(49/62)实现了完全或接近完全闭塞(O'Kelly-Marotta分级C+D),DED植入后为80.0%(32/40)(P = 0.354)。
在并发症发生率、功能结果和动脉瘤闭塞方面,PED组和DED组之间未发现显著差异。