From the Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., J.A.V., R.A.H.), Orlando Health, Orlando, Florida
Department of Neurosurgery (A.I., B.A.), University of Alabama at Birmingham, Birmingham, Alabama.
AJNR Am J Neuroradiol. 2021 Apr;42(4):720-725. doi: 10.3174/ajnr.A7002. Epub 2021 Feb 18.
The Pipeline Embolization Device (PED) is a flow-diverting stent for the treatment of intracranial aneurysms and is used off-label for a subset of ruptured aneurysms not amenable to traditional treatment.
Our aim was to evaluate the safety and efficacy of the PED for treatment of ruptured intracranial aneurysms.
A systematic review of the MEDLINE, EMBASE, and Scopus data bases from January 2011 to March 2020 was performed for articles reporting treatment of ruptured intracranial aneurysms with the PED.
A total of 12 studies comprising 145 patients with 145 treated aneurysms were included for analysis.
Individual patient data were collected. Nonparametric tests were used to compare differences among patients. Logistic regression was used to determine an association with outcome variables.
Mean aneurysm size was 5.9 mm, and most were blister (51.0%) or dissecting (26.9%) in morphology. Three (2.1%) aneurysms reruptured following PED placement. Univariate logistic regression identified larger aneurysm size as a significant predictor of aneurysm rerupture ( = .008). Of patients with radiographic follow-up, 87.5% had complete aneurysm occlusion. Symptomatic neurologic complications occurred in 16.5%.
Analysis was limited by the quality of the included data, most of which were from small case series representing class III medical evidence. No study assessed outcome in a blinded or independently adjudicated manner.
Most ruptured aneurysms treated with the PED were blister or dissecting aneurysms. Treatment was associated with a rerupture rate of 2.1% and a complete occlusion rate of 87.5%.
Pipeline 栓塞装置（PED）是一种用于治疗颅内动脉瘤的血流导向支架，也被用于部分传统治疗方法不可行的破裂动脉瘤。
我们旨在评估 PED 治疗破裂颅内动脉瘤的安全性和有效性。
对 2011 年 1 月至 2020 年 3 月 MEDLINE、EMBASE 和 Scopus 数据库进行了系统回顾，以检索报告使用 PED 治疗破裂颅内动脉瘤的文章。
共纳入 12 项研究，包括 145 例 145 个治疗的动脉瘤患者进行分析。
收集了个体患者数据。使用非参数检验比较患者之间的差异。使用逻辑回归确定与结局变量的关联。
平均动脉瘤大小为 5.9mm，大多数动脉瘤形态为泡状（51.0%）或夹层（26.9%）。3 个（2.1%）动脉瘤在 PED 放置后再次破裂。单变量逻辑回归确定较大的动脉瘤大小是动脉瘤再次破裂的显著预测因素（=0.008）。在有影像学随访的患者中，87.5%的患者完全闭塞了动脉瘤。出现症状性神经并发症的患者占 16.5%。
分析受到纳入数据质量的限制，这些数据大多来自小病例系列，代表 III 级医学证据。没有研究以盲法或独立裁决的方式评估结局。
PED 治疗的大多数破裂动脉瘤为泡状或夹层动脉瘤。治疗后再破裂率为 2.1%，完全闭塞率为 87.5%。
