Literature Review

Safety and efficacy of the Pipeline embolization device for treatment of intracranial aneurysms: a pooled analysis of 3 large studies.

Selected in Journal of Neurosurgery by NEKI Hiroaki

Authors: Kallmes DF, Brinjikji W, Cekirge S, Fiorella D, Hanel RA, Jabbour P, Lopes D, Lylyk P, McDougall CG, Siddiqui A

Reference: J Neurosurg. 2017 Oct;127(4):775-780

Published: October 2017

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Friday 22 December 2017
Summary
  • This article shows a pooled analysis of 3 large studies using PED (Pipeline Embolization Device), IntrePED (International Retrospective Study of the Pipeline Embolization Device), PUFS (Pipeline for Uncoilable or Failed Aneurysms Study), and ASPIRe (Aneurysm Study of Pipeline in an Observational Registry).
  • IntrePED was a retrospective study, while PUFS and ASPIRe were prospective studies. A total of 1092 patients with 1221 aneurysms were included in the 3 studies.
  • As efficiency, the complete occlusion rates were 75.0% at 180 days (111/148) and 85.5% at 1 year (94/110). The overall aneurysm retreatment rate was 3.0% (33/1091) at a mean follow-up time of 10.2 ± 10.8 months.
  • As the safety, the combined major morbidity and neurological mortality rate was 7.1%, morbidity rate was 5.7% and the mortality rate was 3.3%. The major ipsilateral ischemic stroke rate was 3.7%, the major ipsilateral intracranial hemorrhage rate was 2.0%.
Comment

PED was initially developed for wide-neck and large and giant aneurysms. PED has been recognized as an excellent option for patients with intracranial aneurysms gradually.

 To date, a majority of previously published studies are small single-institution case series, and their results may not be generalizable to the overall patient population. We can acquire greater knowledge by this study.

 This study shows PED is a safe and effective device for intracranial aneurysms with a broad range of sizes and locations and ruptured status, though there was no overall standardization in the perioperative management, including the use of platelet testing.

 

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