Pipeline Embolization device for the treatment of unruptured intracranial saccular aneurysms: a systematic review and meta-analysis of long-term outcomes.

INTRODUCTION: The pipeline embolization device (PED) is commonly used for intracranial aneurysm treatment. While its effectiveness for certain types of aneurysms is well-established, its efficacy for saccular aneurysms remains controversial. We aimed to assess the long-term outcomes of PED treatment for unruptured intracranial saccular aneurysms. METHODS: Systematic review and meta-analysis were conducted following PRISMA guidelines. Studies with at least one year of follow-up after PED treatment for saccular aneurysms were included. The primary endpoint was angiographic aneurysm occlusion at long-term follow-up (≥ 12 months), and the secondary outcome was long-term complications. We conducted a meta-regression analysis to explore potential sources of heterogeneity across studies. RESULTS: Eleven studies of 797 patients with 963 aneurysms were included. Long-term angiographic occlusion rate was 85% (95% CI, 77-91%; p < 0.01), symptomatic ischemic stroke rate was 1% (95% CI, 0-3%; p < 0.01), rupture rate was 1% (95% CI, 0-2%; p = 0.02), and intracranial hemorrhage (ICH) rate was 0.2% (95% CI, 0-1%; p = 0.11). Meta-regression analysis revealed a non-significant decreasing trend per year for aneurysmal occlusion, ischemic stroke rate, delayed aneurysmal rupture, and ICH. CONCLUSION: PED demonstrates high long-term occlusion and low complication rates, suggesting it is a safe and effective treatment option for saccular aneurysms. Additionally, newer devices exhibit reduced thrombogenic profiles and safety with decreasing trends in ICH, ischemic stroke, and delayed aneurysmal rupture.

Major Neurological Deficit Following Neck Hyperextension During Dental Treatment: Report of 2 Cases and Review of the Literature.

INTRODUCTION: Medical literature has long reported the disastrous effects of neck hyperextension on posterior cerebral circulation. Hairdresser-related ischemic cerebrovascular event, also called beauty parlor syndrome, among other examples, is considered an epitome of this phenomenon. CASE REPORT: In this report, alluding to hairdresser-related ischemic cerebrovascular event, 2 cases of neurological impairment following hyperextension of the neck during dental treatment append to the many others, yet being 2 of the first reported in this setting. In one of the cases, the patient developed classic stroke symptoms during dental treatment, while in the other, the deficit developed the day after the dental procedure. Both patients were treated with low-molecular-weight heparin during their stay at the hospital. In the first patient, the deficit was permanent, while in the second, the deficit was more subtle and temporary. CONCLUSIONS: Pathogenesis, as well as predisposing factors, are discussed, and new terminology is established as a means to encourage research on this rare complication of neck positioning on dental chairs.