Pipeline Embolization Device With Adjunctive Coils for the Treatment of Unruptured Large or Giant Vertebrobasilar Aneurysms: A Single-Center Experience.

Yangyang Zhou,Xinjian Yang,Shiqing Mu,Xinzhi Wu,Zhongbin Tian

doi:10.3389/fneur.2020.522583

Abstract

Objective: To evaluate effectiveness and safety of Pipeline embolization device (PED) for large or giant verterbrobasilar aneurysms (LGVBAs), and to compare the therapeutic effects of PED with and without adjunctive coils.Methods: We retrospectively analyzed 21 cases of unruptured LGVBAs who were treated in our hospital with PED. These cases were divided into “PED group” and “PED with adjunctive coils group.” We compared the aneurysm characteristics and treatment outcomes between the two groups.Results: The overall neurological complication rate was 28.6% (6/21) and the mortality rate was 4.8% (1/21). There were 12 patients in the PED group and nine in the PED with adjunctive coils group. There were no significant differences in age, smoking, hypertension, aneurysm size, aneurysm location, or operation time between the two groups. The complete aneurysm embolization rate and favorable outcome rate (modified Rankin Scale = 0,1) of the PED with adjunctive coils group was 78% (7/9) and 100% (9/9), respectively, which were both better compared with the PED group with 63.6% (7/11) and 83% (10/12), respectively. However, these differences were not statistically significant.Conclusion: The effectiveness and safety of PED for LGVBAs is acceptable. Treatment results did not differ between the PED and PED with adjunctive coils groups; therefore, whether coils should be used may depend the operator. Our results suggest that correct use of the coils does not increase complications. We suggest that PED with adjunctive coils should be used for some selected LGVBAs.

Highlights

Since gaining U.S Food & Drug Administration approval in April 2011 to treat large or giant wide-necked intracranial aneurysms in the internal carotid artery from the petrous to the superior hypophyseal segments, the Pipeline embolization device (PED; Medtronic, Minneapolis, MN, USA) has been wildly used to treat various intracranial refractory aneurysms
It is necessary to mention that seven patients (33.3%) each presented with two aneurysms, but the other aneurysm was not located in the vertebrobasilar artery or was not large (
Interventional embolization has become the technique of choice for the treatment of large or giant vertebrobasilar aneurysm (LGVBA) [5]; early intervention methods were not effective because of the large aneurysm cavity and loss of effective vascular wall inhibiting stent-assisted coil embolization and vascular remodeling

Summary

Introduction

Since gaining U.S Food & Drug Administration approval in April 2011 to treat large or giant wide-necked intracranial aneurysms in the internal carotid artery from the petrous to the superior hypophyseal segments, the Pipeline embolization device (PED; Medtronic, Minneapolis, MN, USA) has been wildly used to treat various intracranial refractory aneurysms. Among intracranial aneurysms, posterior vertebrobasilar aneurysms remain the most formidable lesions to treat and clinical outcomes can be poor with a high risk of mortality and disability. This is true for large or giant vertebrobasilar fusiform aneurysms, because some of them progress rapidly and are prone to rupture or can compress the brain stem, even in PED-treated cases [7,8,9]. Because of the rarity of large or giant vertebrobasilar aneurysm (LGVBA) cases, there is still little experience of PED treatment for LGVBAs. the combined use of coils is controversial because it can increase the mass effect, which can accelerate aneurysm rupture or compress the brain stem with fatal consequences [13, 14]. This study attempted to evaluate the effectiveness and safety of PED for LGVBAs, and to compare the therapeutic effects of a single-center PED group with a PED with adjunctive coils group

Methods

Results

Discussion

Conclusion