Abstract
BackgroundThis study aimed to investigate clinical and angiographic outcomes of Pipeline embolization device (PED) treatment of large or giant basilar artery (BA) aneurysms and examine associated factors.MethodsClinical and angiographic data of 29 patients (18 men, 11 women) with large or giant BA aneurysms were retrospectively examined. Mean age was 44.1 ± 21.2 years (range, 30–68). Mean aneurysm size was 22.2 ± 8.3 mm (range, 12.0–40.1).ResultsMean angiographic follow-up was 18.3 ± 3.4 months (range, 4.5–60). The rate of adequate aneurysmal occlusion (O'Kelly–Marotta grade C–D) was 87%. The overall complication rate was 44.8%; most complications (84.6%) occurred in the periprocedural period. Univariable comparison of patients who did and did not develop complications showed significant differences in aneurysm size (p < 0.01), intra-aneurysmal thrombus (p = 0.03), and mean number of PEDs used (p = 0.02). Aneurysm size (odds ratio, 1.4; p = 0.04) was an independent risk factor for periprocedural complications in multivariable analysis. Mean clinical follow-up was 23.5 ± 3.2 months (range, 0.1–65). Nine patients (31%) had a poor clinical outcome (modified Rankin scale score ≥3) at last follow-up, including 7 patients who died. Univariable comparisons between patients with favorable and unfavorable clinical outcomes showed that aneurysm size (p = 0.009) and intra-aneurysmal thrombus (p = 0.04) significantly differed between the groups. Multivariable analysis showed that aneurysm size (odds ratio, 1.1; p = 0.04) was an independent risk factor for poor clinical outcome.ConclusionPED treatment of large or giant BA aneurysms is effective and can achieve a satisfactory long-term occlusion rate. However, the treatment complications are not negligible. Aneurysm size is the strongest predictor of perioperative complications and poor clinical outcome.
Highlights
Large (≥10 mm) or giant (>25 mm) basilar artery (BA) aneurysms have a poor natural history
We retrospectively collected the data of consecutive patients with large or giant BA aneurysms who were electively treated using the Pipeline embolization device (PED) at our center from January 2016 to October 2020
Twenty-nine patients with a large or giant BA aneurysm were treated using the PED during the study period (18 men, 11 women)
Summary
Large (≥10 mm) or giant (>25 mm) basilar artery (BA) aneurysms have a poor natural history. They are clinically characterized by thrombosis or mass effect on the brainstem, which can cause death if left untreated [1, 2]. Elective treatment of posterior circulation aneurysms using either surgical or traditional endovascular techniques can result in poor outcomes [4]. In the treatment of large or giant aneurysms, Pipeline embolization device (PED; Medtronic, Minneapolis, MN, USA) treatment has a much higher success rate than other endovascular techniques. This study aimed to investigate clinical and angiographic outcomes of Pipeline embolization device (PED) treatment of large or giant basilar artery (BA) aneurysms and examine associated factors
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