Zhang Huachen, Ren Jiyang, Wang Jiangdian, Lv Xianli
Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Center for Statistical Science and Department of Industrial Engineering, Tsinghua University, Beijing, China.
Interv Neuroradiol. 2025 Apr;31(2):158-167. doi: 10.1177/15910199221148800. Epub 2022 Dec 30.
ObjectiveTo describe the off-label uses of pipeline embolization device for a variety of types of aneurysms including ruptured aneurysms, posterior circulation aneurysms, small aneurysms, distal aneurysms, and recurrent aneurysms.MethodsClinical and angiographic data of patients who underwent pipeline embolization device treatment on off-label use at our center were retrospectively reviewed. For categorical variables, Fisher's exact test was used, and a two-sample Wilcoxon rank-sum test was used for patients' age to analyze the correlation with outcomes.ResultsIn this study, 121 aneurysms in 107 patients received off-label pipeline embolization device treatments. The overall rate of complete aneurysm occlusion was 77.8% (28/36 in 35 patients) for posterior circulation aneurysms and 95.3% (81/85 in 72 patients) for anterior circulation aneurysms. The posterior circulation aneurysms have a lower rate of aneurysm occlusion (= 0.0372). The small aneurysms have a higher rate of aneurysm occlusion (= 0.0104). The patient's sex, age, and aneurismal size were associated with ischemic stroke complications ( = 0.0397, 0.0166, and 0.0178). In posterior circulation aneurysm patients, only two basilar apex aneurysms underwent pipeline embolization device treatment, both of whom died of thrombotic complications. There was no difference in mortality between posterior circulation aneurysm patients (8.6%, 3/35) and anterior circulation aneurysm patients (1.4%, 1/72) ( = 0.1015). Patients of older age have a higher risk of death rate (= 0.0053).ConclusionsThe off-label use of pipeline embolization device is often performed in clinical practice and can achieve efficacy in complex aneurysms. The off-label use of pipeline embolization device was found to carry an increased rate of mortality in older patients. Excluding basilar apex aneurysms, the pipeline embolization device is as safe as anterior circulation aneurysms in the treatment of posterior circulation aneurysms elsewhere.
目的
描述血流导向装置在多种类型动脉瘤（包括破裂动脉瘤、后循环动脉瘤、小型动脉瘤、远端动脉瘤和复发动脉瘤）中的非标签使用情况。
方法
回顾性分析在本中心接受血流导向装置非标签使用治疗的患者的临床和血管造影数据。对于分类变量，采用Fisher精确检验，对患者年龄采用两样本Wilcoxon秩和检验以分析与预后的相关性。
结果
在本研究中，107例患者的121个动脉瘤接受了血流导向装置非标签使用治疗。后循环动脉瘤的总体动脉瘤完全闭塞率为77.8%（35例患者中的28/36），前循环动脉瘤为95.3%（72例患者中的81/85）。后循环动脉瘤的动脉瘤闭塞率较低（P = 0.0372）。小型动脉瘤的动脉瘤闭塞率较高（P = 0.0104）。患者的性别、年龄和动脉瘤大小与缺血性卒中并发症相关（P = 0.0397、0.0166和0.0178）。在后循环动脉瘤患者中，仅2例基底动脉尖部动脉瘤接受了血流导向装置治疗，均死于血栓形成并发症。后循环动脉瘤患者（8.6%，3/35）和前循环动脉瘤患者（1.4%，1/72）的死亡率无差异（P = 0.1015）。年龄较大的患者死亡率风险较高（P = 0.0053）。
结论
血流导向装置的非标签使用在临床实践中经常进行，并且在复杂动脉瘤中可取得疗效。发现血流导向装置的非标签使用在老年患者中死亡率增加。除基底动脉尖部动脉瘤外，血流导向装置在其他部位后循环动脉瘤的治疗中与前循环动脉瘤一样安全。
