Hiramatsu Ryo, Yagi Ryokichi, Kameda Masahiro, Nonoguchi Naosuke, Furuse Motomasa, Kawabata Shinji, Ohnishi Hiroyuki, Miyachi Shigeru, Wanibuchi Masahiko
Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.
Department of Neurosurgery, Ohnishi Neurological Center, Akashi, Hyogo, Japan.
J Neuroendovasc Ther. 2023;17(10):217-223. doi: 10.5797/jnet.oa.2023-0027. Epub 2023 Aug 15.
This study aimed to report the outcome of an endovascular treatment with a pipeline embolization device (PED) at a single center. We also examined the predictive factors for an incomplete occlusion after the PED placement.
The subjects were 94 patients with 109 aneurysms who underwent the PED placement at our single center from June 2015 to September 2022. As treatment outcomes, we investigated the PED placement success rate, perioperative morbidity and mortality, postoperative cranial nerve improvement rate, and the classification of angiographic result at 6 months after the PED placement. Furthermore, the predictors of an incomplete occlusion were investigated in detail.
One hundred nine aneurysms locations were: C1 (9), C2 (30), C3 (15), C4 (53), and C5 (2) in the internal carotid artery segments. Perioperative morbidity, including the asymptomatic ones, occurred in 10 cases (10.6%). Among these 10 cases, the modified Rankin Scale (mRS) improved to preoperative mRS after 90 days in 9 cases except 1 case. On the other hand, no perioperative mortality was observed. The postoperative cranial nerve improvement rate was 84.4%, and 61.7% of patients had a complete occlusion in the follow-up angiography, 6 months after the PED placement. Predictive factors for an incomplete occlusion after the PED placement were the elderly aged 70 years or older (-value = 0.0214), the elderly aged 75 years or older (-value = 0.0009), and the use of anticoagulants (-value = 0.0388) in an univariate analysis. Further, the multivariate analysis revealed that the elderly aged 75 years or older was a predictive factor of an incomplete occlusion in this study.
We summarized the outcomes of the PED treatment at our single center. In this study, the elderly aged 75 years or older was a predictive factor of an incomplete occlusion after the PED placement.
本研究旨在报告单中心使用Pipeline栓塞装置（PED）进行血管内治疗的结果。我们还研究了PED置入后不完全闭塞的预测因素。
研究对象为2015年6月至2022年9月在我们单中心接受PED置入的94例患者的109个动脉瘤。作为治疗结果，我们调查了PED置入成功率、围手术期发病率和死亡率、术后颅神经改善率以及PED置入后6个月的血管造影结果分类。此外，还详细研究了不完全闭塞的预测因素。
109个动脉瘤的位置分别为：颈内动脉段C1（9个）、C2（30个）、C3（15个）、C4（53个）和C5（2个）。围手术期发病率（包括无症状者）发生在10例（10.6%）。在这10例中，除1例患者外，9例患者在90天后改良Rankin量表（mRS）改善至术前mRS。另一方面，未观察到围手术期死亡。术后颅神经改善率为84.4%，在PED置入后6个月的随访血管造影中，61.7%的患者完全闭塞。单因素分析显示，PED置入后不完全闭塞的预测因素为70岁及以上老年人（P值=0.0214）、75岁及以上老年人（P值=0.0009）以及使用抗凝剂（P值=0.0388）。此外，多因素分析显示，75岁及以上老年人是本研究中不完全闭塞的预测因素。
我们总结了单中心PED治疗的结果。在本研究中，75岁及以上老年人是PED置入后不完全闭塞的预测因素。
