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Declining complication rates with flow diversion of anterior circulation aneurysms after introduction of the Pipeline Flex: analysis of a single-institution series of 568 cases.
Colby, Geoffrey P; Bender, Matthew T; Lin, Li-Mei; Beaty, Narlin; Caplan, Justin M; Jiang, Bowen; Westbroek, Erick M; Varjavand, Bijan; Campos, Jessica K; Huang, Judy; Tamargo, Rafael J; Coon, Alexander L.
Afiliação
  • Colby GP; 1Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland; and.
  • Bender MT; 1Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland; and.
  • Lin LM; 2Department of Neurosurgery, University of California Irvine, Orange, California.
  • Beaty N; 1Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland; and.
  • Caplan JM; 1Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland; and.
  • Jiang B; 1Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland; and.
  • Westbroek EM; 1Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland; and.
  • Varjavand B; 1Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland; and.
  • Campos JK; 1Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland; and.
  • Huang J; 1Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland; and.
  • Tamargo RJ; 1Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland; and.
  • Coon AL; 1Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland; and.
J Neurosurg ; 129(6): 1475-1481, 2018 12 01.
Article em En | MEDLINE | ID: mdl-29327999
OBJECTIVEThe second-generation Pipeline embolization device (PED), Flex, has several design upgrades, including improved opening and the ability to be resheathed, in comparison with the original device (PED classic). The authors hypothesized that Flex is associated with a lower rate of major complications.METHODSA prospective, IRB-approved, single-institution database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion. The PED classic was used from August 2011 to January 2015, and the Pipeline Flex has been used since February 2015.RESULTSA total of 568 PED procedures (252 classic and 316 Flex) were performed for anterior circulation aneurysms. The average aneurysm size was 6.8 mm. Patients undergoing treatment with the Flex device had smaller aneurysms (p = 0.006) and were more likely to have undergone previous treatments (p = 0.001). Most aneurysms originated along the internal carotid artery (89% classic and 75% Flex) but there were more anterior cerebral artery (18%) and middle cerebral artery (7%) deployments with Flex (p = 0.001). Procedural success was achieved in 96% of classic and 98% of Flex cases (p = 0.078). Major morbidity or death occurred in 3.5% of cases overall: 5.6% of classic cases, and 1.9% of Flex cases (p = 0.019). On multivariate logistic regression, predictors of major complications were in situ thrombosis (OR 4.3, p = 0.006), classic as opposed to Flex device (OR 3.7, p = 0.008), and device deployment in the anterior cerebral artery or middle cerebral artery as opposed to the internal carotid artery (OR 3.5, p = 0.034).CONCLUSIONSFlow diversion of anterior circulation cerebral aneurysms is associated with an overall low rate of major complications. The complication rate is significantly lower since the introduction of the second-generation PED (Flex).
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Aneurisma Intracraniano / Embolização Terapêutica Tipo de estudo: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Aneurisma Intracraniano / Embolização Terapêutica Tipo de estudo: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2018 Tipo de documento: Article