ArticleFrontiers in neurology
Multicenter experience of pipeline embolization device used in small caliber vessels (< 2 mm) for intracranial aneurysm treatment and mid-term results.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Flow diversion stents (FDS), particularly the Pipeline Embolization Device (PED), have been widely used for intracranial aneurysm (IA) treatment. However, data on PED deployment in small-caliber parent vessels (< 2 mm) remain limited. This study aimed to evaluate the technical feasibility, safety, and efficacy of PED for IAs arising from small-caliber vessels. Methods: This was a multicenter retrospective study enrolling 71 eligible patients with IA located in parent vessels < 2 mm who underwent PED implantation. The primary safety endpoint included procedure-related death, symptomatic stroke, intracranial hemorrhage and asymptomatic in-stent stenosis; the primary efficacy endpoint was complete aneurysm occlusion [O'Kelly-Marotta (OKM) grade D] on follow-up digital subtraction angiography (DSA). Binary logistic regression analyses were used to identify factors associated with complications and delayed IA occlusion. Results: The patient age was 55 (47, 59) years, with 37 (52.1%) males. The follow-up duration was 9 (7, 15) months. Postoperative complications included ischemic events (16.9%), hemorrhagic events (4.2%), and asymptomatic in-stent stenosis (12.7%). The 1-year complete occlusion rate was 52%, whereas the long-term occlusion rate gradually increased to 80% with follow-up beyond 12 months. Univariable analysis showed PED length was associated with both delayed IA occlusion [odds ratio (OR) = 0.91, 95% confidence interval (CI) = 0.83-1.00; Conclusion: PED deployment in small-caliber parent vessels (<2 mm) is technically feasible and clinically viable, with favorable IA occlusion rates and an acceptable safety profile. These findings support the off-label use of PEDs in this challenging cohort, provided rigorous patient selection, optimal procedural planning and close follow-up are implemented.
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