Article Figures & Data
Figures
- Fig 1.
Digital subtraction angiography shows a basilar tip saccular aneurysm before treatment with the Pipeline Embolization Device (A). The PED was placed spanning the lower part of the basilar truck into the left posterior cerebral artery. On 4-month follow-up (B), DSA shows complete aneurysm occlusion, along with complete occlusion of the right PCA. The anterior inferior cerebral arteries and superior cerebellar arteries remained patent. The patient remained neurologically intact.
- Fig 2.
Digital subtraction angiography shows 2 basilar trunk saccular aneurysms before treatment with the Pipeline Embolization Device (A). The PED was placed spanning the AICA bilaterally. On follow-up DSA (B), there was complete occlusion of the left AICA. The patient had a symptomatic left-sided pontine stroke that remained symptomatic at 10-month follow-up (C).
Tables
Parameter No. No. of procedures 129 No. of aneurysms 131 No. of branches covered 228 Sex Female 82 (63.6%) Male 47 (36.4%) Median age (range) (yr) 58 (29–82) Smokinga 40 (33.3%) Multiple aneurysms 32 (24.8%) Presenting symptoms Asymptomatic 28 (21.7%) Headache/dizziness 30 (23.3%) Neurologic deficit 71 (55%) Subarachnoid hemorrhage Immediate (<24 hr) 18 (14.0%) Acute (>24 hr and <2 wk) 7 (5.4%) Remote (>2 wk) 14 (10.9%) Pretreatment mRS 0–2 101 (78.3%) 3–5 28 (21.7%) Aneurysm shape Saccular 49 (37.4%) Fusiform 53 (40.5%) Dissecting 29 (22.1%) Aneurysm location Vertebral artery 46 (35.1%) PICA 10 (7.6%) Vertebrobasilar artery 18 (13.6%) Basilar artery 45 (34.5%) SCA 4 (3.1%) PCA 8 (6.1%) Aneurysm measurements (median) (range) (mm) Maximal diameter 12 (2–73) Neck size (for saccular aneurysms) 5.35 (2–15) Daughter sac 26 (19.8%) Prior treatment Endovascular 14 (10.7%) Surgery 2 (1.5%) Both 1 (0.8%) Platelet function test 77 (59.7%) Clopidogrel nonresponders 14 (18.2%) Treatment of nonresponders Continue clopidogrel 8 (57.1%) Switch to ticagrelor 5 (35.8%) Other 1 (7.1%) Note:—SCA indicates superior cerebellar artery.
↵a Data are missing for 9 procedures.
Parameter No. No. of Pipelines deployed (median) (range) 1 (1–14) Adjunctive coiling 40 (31%) Procedures with covered branches 103 (79.8%) No. of covered branches (median) (range) 2 (0–6) Last angiographic follow-up (median) (range) (mo)a 11 (1–72) Follow-up aneurysm occlusion ratea Complete (100%) 85 (66.4%) Near-complete (90%–99%) 15 (11.7%) Partial (<90%) 28 (21.9%) Retreatment Endovascular 11 (8.4%) Outcome of covered branchesb 228 Occluded (overall) 25 (11%) VA 23 Occluded 8 (34.8%) PICA 49 Occluded 4 (8.2%) AICA 78 Occluded 6 (7.7%) SCA 61 Occluded 3 (4.9%) PCA 17 Occluded 4 (23.5%) Last clinical follow-up (median) (range) (mo)c 8 (0.3–72) Posttreatment mRSc 0–2 99 (79.2%) 3–5 12 (9.6%) 6 (Death) 14 (11.2%) Follow-up mRSc Improved 43 (34.4%) No change 54 (43.2%) Worsened 28 (22.4%) Ischemic complications 29 (22.5%) Timing Intraprocedural 2 (1.6%) Postprocedural 27 (20.9%) Location Brain stem 13 (10.1%) Cerebellum 13 (10.1%) PCA territory 10 (7.8%) Symptomatic 17 (13.2%) Temporary 6 (4.7%) Permanent 11 (8.5%) Territory of ischemic complications Same as covered branch 21 (72.4%) Different 8 (27.6%) Parameter Branch Occlusion (No.) (%) P Value Not Occluded (n = 203) Occluded (n = 25) Sex Female 108 (87.1%) 16 (12.9%) .3 Male 95 (91.3%) 9 (8.7%) Median age (range) (yr) 59.5 (29–82) 61 (42–78) .56 Smokinga Yes 53 (82.8%) 11 (17.2%) .1 No 137 (90.7%) 14 (9.3%) Presenting symptoms Asymptomatic 32 (72.7%) 12 (27.3%) <.001 Headache/dizziness 38 (88.4%) 5 (11.5%) Neurologic deficit 133 (94.3%) 8 (5.7%) Subarachnoid hemorrhage No 141 (87.6%) 20 (12.4%) .36 Acute (<24 hr) 25 (96.2%) 1 (3.8%) Immediate (<2 wk) 11 (100%) 0% Remote (>2 wk) 26 (86.7%) 4 (13.3%) Pretreatment mRS 0–2 160 (87.4%) 23 (12.6%) .12 3–5 43 (95.6%) 2 (4.4%) Aneurysm shape Saccular 74 (84.1%) 14 (15.9%) .18 Fusiform 89 (91.8%) 8 (8.2%) Dissecting 38 (92.7%) 3 (7.3%) Aneurysm measurements Maximal diameter <7 mm 32 (84.2%) 6 (15.8%) .23 7–12 mm 50 (84.7%) 9 (15.3%) 13–24 mm 52 (89.7%) 6 (10.3%) >24 mm 69 (94.5%) 4 (5.5%) Daughter sac Yes 45 (90%) 5 (10%) .8 No 158 (88.8%) 20 (11.2%) Intra-aneurysmal thrombus Yes 68 (94.4%) 4 (5.6%) .08 No 135 (86.5%) 21 (13.5%) Prior treatment No 174 (88.3%) 23 (11.7%) .8 Endovascular 25 (92.6%) 2 (7.4%) Surgery 3 (100%) 0% Both 1 (100%) 0% Platelet function testing Yes 128 (85.3%) 22 (14.7%) .01 No 75 (96.2%) 3 (3.8%) Clopidogrel respondersb Yes 110 (86.6%) 17 (13.4%) .3 No 18 (78.3%) 5 (21.7%) Adjunctive coiling Yes 75 (88.2%) 10 (11.8%) .77 No 128 (89.5%) 15 (10.5%) No. of Pipelines deployed (median) (range) 1 (1–14) 1 (1–4) .33 Length of procedure (median) (range) (min) 110 (22–410) 114 (32–271) .8 Branch VA 15 (65.2%) 8 (34.8%) .001 PICA 45 (91.8%) 4 (8.2%) AICA 72 (92.3%) 6 (7.7%) SCA 58 (95.1%) 3 (4.9%) PCA 13 (76.5%) 4 (23.5%) No. of covered branches in same procedure 1 37 (97.4%) 1 (2.6%) .07 ≥2 166 (87.4%) 24 (12.6%)
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