Montefiore Department of Neurological Surgery, Bronx, New York, USA.
Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
World Neurosurg. 2022 May;161:e384-e394. doi: 10.1016/j.wneu.2022.02.025. Epub 2022 Feb 10.
To compare safety and efficacy profiles in aneurysms treated with Pipeline Embolization Device or Pipeline Flex versus Surpass Streamline flow diverters (FDs).
Patients who underwent flow diversion for aneurysm treatment at 2 centers were included. Covariates comprised patient demographics, comorbidities, and aneurysm characteristics. Metrics included number of devices, adjuvant device use, case duration, and radiation exposure. Outcomes included periprocedural complications and radiographic results at follow-up. Propensity score-matched pairs were generated using demographic and aneurysm characteristics to verify the outcomes in equally sized groups.
The majority of 141 flow diversion procedures performed on 126 patients were in the anterior circulation (96%) and unruptured (93%). Operators experienced more complications placing Surpass FDs compared with Pipelines (18.2% vs. 3.1%, P = 0.005) but used fewer Surpass devices per case (1 device in all Surpass cases and range for Pipeline cases 1-7; P < 0.001). Ballooning was more frequent for Surpass (29.5% vs. 2.1%, P < 0.001). There were no differences in mortality (2.1% vs. 0, P = 1.00), intracranial hemorrhage (3.1% vs. 0, P = 0.551), or stroke (4.2% vs. 6.8%, P = 0.680). Rates of aneurysm obliteration at follow-up were similar. Propensity-matched pairs had no differences in FD deployment complications or perioperative events, yet the significant differences remained for adjuvant balloon use and number of FDs deployed.
While the devices demonstrated similar safety and efficacy profiles, deployment of the Surpass Streamline was more technically challenging than Pipeline Embolization Device or Pipeline Flex. Prospective cohort studies are needed to corroborate these findings.
比较使用 Pipeline Embolization Device 或 Pipeline Flex 与 Surpass Streamline 血流导向装置（FD）治疗动脉瘤的安全性和疗效。
纳入在 2 个中心接受血流导向装置治疗的动脉瘤患者。协变量包括患者人口统计学特征、合并症和动脉瘤特征。评估指标包括装置数量、辅助装置使用、手术时间和辐射暴露。结果包括围手术期并发症和随访时的影像学结果。使用人口统计学和动脉瘤特征生成倾向评分匹配对，以验证大小相等的组中的结果。
126 例患者共进行了 141 例血流导向装置治疗，其中 96%在前循环，93%为未破裂动脉瘤。与 Pipeline 相比，术者在放置 Surpass FD 时并发症更多（18.2% vs. 3.1%，P=0.005），但每个病例使用的 Surpass FD 更少（所有 Surpass 病例均使用 1 个装置，Pipeline 病例范围为 1-7 个；P<0.001）。Surpass 更常进行球囊扩张（29.5% vs. 2.1%，P<0.001）。死亡率（2.1% vs. 0，P=1.00）、颅内出血（3.1% vs. 0，P=0.551）或卒（4.2% vs. 6.8%，P=0.680）无差异。随访时的动脉瘤闭塞率相似。倾向评分匹配对在 FD 放置并发症或围手术期事件方面无差异，但辅助球囊使用和 FD 数量仍存在显著差异。
虽然这些装置具有相似的安全性和疗效，但 Surpass Streamline 的部署比 Pipeline Embolization Device 或 Pipeline Flex 更具挑战性。需要前瞻性队列研究来证实这些发现。
