• Neurosurgery · Feb 2020

    Multicenter Study

    The Pipeline Embolization Device: Changes in Practice and Reduction of Complications in the Treatment of Anterior Circulation Aneurysms in a Multicenter Cohort.

    • Adam A Dmytriw, Kevin Phan, Mohamed M Salem, Nimer Adeeb, Justin M Moore, Christoph J Griessenauer, Paul M Foreman, Hussain Shallwani, Hakeem Shakir, Adnan H Siddiqui, Elad I Levy, Jason M Davies, Mark R Harrigan, Ajith J Thomas, and Christopher S Ogilvy.
    • Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
    • Neurosurgery. 2020 Feb 1; 86 (2): 266-271.

    BackgroundThe Pipeline Embolization Device (PED; Medtronic, Dublin, Ireland) has become an important tool for the treatment of cerebral aneurysms. Since FDA approval, there are ongoing efforts to increase aneurysm occlusion rates and reduce the incidence of complications.ObjectiveTo assess aneurysm occlusion and complication rates over time.MethodsRetrospective analysis of consecutive anterior circulation aneurysms treated with a single PED between 2011 and 2016 at 3 academic institutions in the US was performed. Factors contributing to changes in aneurysm occlusion and complication rates over time were identified and evaluated.ResultsA total of 284 procedures were performed on 321 anterior circulation aneurysms in 284 patients. At a median follow-up of 13 mo (mean 18 mo), complete or near complete occlusion (>90%) was achieved in 85.9% of aneurysms. There was no significant change in aneurysm occlusion rate or procedure length over time. Thromboembolic complication occurred in 8.1% of procedures, and there was a trend toward decreased incidence from 16.3% in 2011/2012 to 3.3% in 2016 (P = .14). Hemorrhagic complications significantly decreased from 8.2% in 2011/2012 to 0 to 1.0% in 2014-2016 (P = .1).ConclusionWe report a notable drop in the rate of hemorrhagic and to a lesser extent thromboembolic complications with increased experience with PED in a multicenter cohort. Multiple factors are believed to contribute to this drop, including the evolved interpretation of platelet function testing, the switching of clopidogrel nonresponders to ticagrelor, and the reduced use of adjunctive coiling.Copyright © 2019 by the Congress of Neurological Surgeons.

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