Endovascular Treatment Of Unruptured Giant Intracranial Aneurysms With The Pipeline Embolization Device: A Multicenter Cohort Study.

RATIONALE AND OBJECTIVES: To analyze the complications and mid-to-long-term results of Pipeline embolization device (PED, Covidien/Medtronic) treatment for giant intracranial aneurysms (GIAs), and identify predictors of outcomes.

MATERIALS AND METHODS: We retrospectively analyzed the data from the PLUS registry and identified all patients with GIAs for further evaluation.

RESULTS: A total of 137 patients (137 GIAs) were included in this study. Of these, 118 (86.1%) were saccular, and 13 (9.5%) were located in the posterior circulation. PED-assisted coiling was performed in 96 patients (70.1%), and 20 patients (14.6%) received overlapping PED deployment. Early postoperative complications occurred in 15 patients (10.9%). The median duration of clinical follow-up was 15.0 months (IQR, 12.0-24.0). The overall complication rate was 13.1% (18/137), including 12 ischemic events and 6 hemorrhagic events. The mortality rate was 2.2% (3/137). At the final follow-up, 123 of 130 patients (94.6%) were functioning independently. Multivariable logistic regression analysis identified posterior circulation aneurysms [OR, 6.01, 95% CI: 1.40-25.78; P=0.016], PED deployment adjustment [OR, 4.96, 95% CI: 1.35-18.25; P=0.016] and diabetes [OR, 10.34, 95% CI: 1.02-104.42; P=0.048] as factors independently associated with overall complications. Angiographic follow-up was available for 97 patients (70.8%), with a median follow-up duration of 7.0 months (IQR, 5.0-9.0). The complete occlusion rate was 75.3% (73/97).

CONCLUSION: In this retrospective multicenter study, PED treatment for unruptured GIAs was associated with favorable angiographic and clinical outcomes. Posterior circulation aneurysms, comorbid diabetes, and PED adjustment were significantly associated with a higher risk of overall complications.