Abstract
Flow diversion to treat cerebral aneurysms has revolutionized neurointerventional surgery. Because the addition of coils potentially increases the time and complexity of endovascular procedures, we sought to determine whether adjunctive coil use is associated with an increase in complications. Patients in the International Retrospective Study of Pipeline Embolization Device registry were divided into those treated with the Pipeline Embolization Device alone (n = 689 patients; n = 797 aneurysms; mean aneurysm size, 10.3 ± 7.6 mm) versus those treated with the Pipeline Embolization Device and concurrent coil embolization (n = 104 patients; n = 109 aneurysms; mean aneurysm size, 13.6 ± 7.8 mm). Patient demographics and aneurysm characteristics were examined. Rates of neurologic morbidity and mortality were compared between groups. The Pipeline Embolization Device with versus without coiling required a significantly longer procedure time (135.8 ± 63.9 versus 96.7 ± 46.2 min; P < .0001) and resulted in higher neurological morbidity (12.5% versus 7.8%; P = .13). These data suggest that either strategy represents an acceptable risk profile in the treatment of complex cerebral aneurysms and warrants further investigation.
Highlights
MethodsThis study is a subanalysis of IntrePED registry data obtained from a multicenter, observational, international registry of patients treated with the Pipeline Embolization Device (PED)
The registry included 793 patients with 906 aneurysms: 689 patients with 797 aneurysms were treated with the Pipeline Embolization Device (PED) alone, and 104 patients with 109 aneurysms were treated with PED/coil (Table 1)
Sex, and length of follow-up were well matched, procedure times were significantly increased for the PED/coil cohort compared with the PED alone group (135.8 Ϯ 63.9 minutes versus 96.7 Ϯ 46.2 minutes, P Ͻ .0001)
Summary
This study is a subanalysis of IntrePED registry data obtained from a multicenter, observational, international registry of patients treated with the PED. The primary objective of IntrePED was to identify any neurologic events following treatment with the PED. The IntrePED registry includes patients treated with the PED starting in July 2008 and concluding in July 2013, following the enrollment of 793 patients. Details regarding the institutional review board and ethics committee approvals, patient population, and protocol requirements are described in the primary IntrePED article.[17]. This subanalysis was performed to compare the safety outcomes of patients treated with the PED alone (PED group) with those of patients treated with the PED and adjunctive coil embolization (PED/coil group).
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