Safety Evaluation and Flow Modification in the Anterior Cerebral Artery after Pipeline Embolization Device Deployment across the Internal Carotid Artery Terminus.

Chao Xu,Pei Wu,Bowen Sun,Shancai Xu,Huaizhang Shi,Chunlei Wang,Jianyi Han,Qingchun Mu,Bin Luo,Xinjian Yang,Guoxin Ni

doi:10.1155/2021/6657595

Abstract

Method The clinical and imaging data of PEDs in the postmarket multicenter registry study (PLUS) in China were retrospectively analyzed, and patients were divided into two groups on the basis of the follow-up angiographic results: group 1 (no significant change in A1 blood flow) and group 2 (A1 occlusion or decreased blood flow). We collected patients' baseline data and evaluated the following imaging indicators: diameter and ratio of bilateral A1, M1, and internal carotid artery (ICA) vessels before stenting and the ratio of the PED size (sPED) to the ipsilateral ICA (I-ICA) diameter on the implantation side. Results A total of 1171 patients were included, of whom 48 met the inclusion criteria (17 in group 1 and 31 in group 2). In group 2, three patients experienced neurological deterioration at follow-up. From the univariate analysis of outcomes, single PED without coils, incomplete aneurysm occlusion (IAO), maximum aneurysm diameter, aneurysms involving the ICA bifurcation (ICAb), and large sPED/I-ICA diameter ratio were included in the multivariate analysis (P < 0.20). The multivariate regression analysis results showed that the ratio of sPED/I-ICA diameter was the factor influencing A1 vessel occlusion. The area under the ROC curve was 73.2%. When the sPED/I-ICA diameter ratio was 1.14, sensitivity was 70.6%, and specificity was 77.4%. Conclusion When an oversized PED is placed from M1 to the ICA, the higher porosity formed at the covered A1 orifice is conducive to maintaining stable A1 blood flow and reducing the risk of A1 vessel occlusion. This trial is registered with ClinicalTrials.gov identifier: NCT03831672.

Highlights

Pipeline embolization devices (PEDs) are an alternative treatment for complex intracranial aneurysms; there remains a risk of occlusion of jailed side branches, even in patients with good efficacy with antiplatelet drug therapy [1, 2]
Inclusion criteria were as follows: (1) for intracranial aneurysms treated with a pipeline embolization devices (PEDs), a single PED was deployed from the M1 segment to the internal carotid artery (ICA) and covered the orifice of A1 and (2) follow-up digital subtraction angiography (DSA) imaging data
Aneurysms occurred at the following locations: 4 in the cavernous sinus segment, 13 in the ophthalmic artery segment, 16 in the posterior communicating segment, 2 in the anterior choroidal artery origin, and 12 in the ICA bifurcation (ICAb); the remaining 4 aneurysms were middle cerebral artery (MCA) aneurysms

Summary

Introduction

Pipeline embolization devices (PEDs) are an alternative treatment for complex intracranial aneurysms; there remains a risk of occlusion of jailed side branches, even in patients with good efficacy with antiplatelet drug therapy [1, 2]. The clinical and imaging data of PEDs in the postmarket multicenter registry study (PLUS) in China were retrospectively analyzed, and patients were divided into two groups on the basis of the follow-up angiographic results: group 1 (no significant change in A1 blood flow) and group 2 (A1 occlusion or decreased blood flow). When an oversized PED is placed from M1 to the ICA, the higher porosity formed at the covered A1 orifice is conducive to maintaining stable A1 blood flow and reducing the risk of A1 vessel occlusion. This trial is registered with ClinicalTrials.gov identifier: NCT03831672

Methods

Results

Conclusion