In-Pipeline Stenosis: Incidence, Predictors, and Clinical Outcomes.

Abstract:

BACKGROUND:The Pipeline Embolization Device is a widely utilized flow diverter in the treatment of intracranial aneurysms. OBJECTIVE:To assess the incidence, clinical significance, predictors, and outcomes of in-Pipeline stenosis (IPS). METHODS:Angiographic studies in 139 patients treated between 2011 and 2013 were independently reviewed by 2 authors for the presence of IPS. Multivariable logistic regression analysis was conducted to determine predictors of IPS. RESULTS:A total of 21 (15.8%) patients demonstrated some degree of IPS during the follow-up period at a mean time point of 6.7 months (range, 3-24 months). The stenosis was mild (<50%) in 11 patients, moderate (50%-75%) in 5, and severe (>75%) in 6. None were symptomatic or required further intervention. Sixteen of these 22 patients (73%) had IPS detected within 6 months. IPS was noted in 7.6% (1/13) of patients with posterior circulation aneurysms vs 16.7% (21/126) of those with anterior circulation aneurysms (P = .03). The rate of IPS was 60% (3/5) in patients who did not receive aspirin vs only 14.2% (19/134) in those who received aspirin (P = .02). In multivariable analysis, no aspirin therapy (odds ratio, 10.0; 95% confidence interval, 1.4-67.7; P = .02) and internal carotid artery aneurysm location (odds ratio, 3.1; 95% confidence interval, 1.1-8.8; P = .03) were strong independent predictors of IPS. CONCLUSION:IPS is a common, early, and mostly benign complication. Patients with internal carotid artery aneurysms are more likely to develop IPS. Aspirin plays a key role in preventing IPS. The results of this study further support the safety of flow diverters. ABBREVIATIONS:IPS, in-Pipeline stenosisPED, Pipeline Embolization Device.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Chalouhi N,Polifka A,Daou B,Kung D,Barros G,Tjoumakaris S,Gonzalez LF,Starke RM,Hasan D,Judy B,Rosenwasser RH,Jabbour P

doi

10.1227/NEU.0000000000000908

subject

Has Abstract

pub_date

2015-12-01 00:00:00

pages

875-9; discussion 879

issue

6

eissn

0148-396X

issn

1524-4040

journal_volume

77

pub_type

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