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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
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Impact of age on cerebral aneurysm occlusion after flow diversion

Anna Luisa Kühn1, Peter Kan2, Nils Henninger3

  • 1Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, MA, USA.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|May 11, 2019
PubMed

Insights

The pipeline embolization device (PED) is safe and effective for unruptured intracranial aneurysms (UIA) across all age groups. Older patients showed slightly lower occlusion rates, suggesting a need for further age-related outcome studies.

Area of Science:

  • Neuroendovascular Surgery
  • Cerebrovascular Diseases
  • Medical Device Technology

Background:

  • Unruptured intracranial aneurysms (UIA) pose a risk of rupture and hemorrhage.
  • The Pipeline Embolization Device (PED) is a neurothrombectomy device used for treating complex aneurysms.
  • Evaluating device safety and efficacy across diverse patient demographics, particularly age, is crucial for clinical application.

Purpose of the Study:

  • To assess the safety and effectiveness of the Pipeline Embolization Device (PED) in treating unruptured intracranial aneurysms (UIA).
  • To compare treatment outcomes in different age groups: young (≤45 years), middle-aged (46 to <65 years), and older (≥65 years).
  • To identify potential age-related factors influencing aneurysm occlusion rates after PED treatment.

Main Methods:

  • Retrospective analysis of patients with UIA treated with PED between 2011 and 2017.
  • Patients were categorized into three age groups: young, middle-aged, and older.
  • Vascular risk factors, symptoms, mRS, and follow-up imaging (occlusion rates) and clinical outcomes were collected and analyzed.

Main Results:

  • A total of 260 patients with 307 UIAs were included; 2.3% experienced overall morbidity and mortality.
  • Near-complete to complete aneurysm occlusion rates at 12-18 months were 100% (young), 91.4% (middle-aged), and 78.4% (older).
  • Older patients had significantly lower rates of complete aneurysm occlusion by 3 years compared to younger subjects (p=0.009).

Conclusions:

  • The Pipeline Embolization Device (PED) demonstrates feasibility and safety for treating unruptured intracranial aneurysms (UIA) across all age demographics.
  • While generally effective, older patients exhibited a trend towards lower long-term occlusion rates.
  • Further research is warranted to elucidate age-specific factors impacting aneurysm occlusion post-PED treatment and to refine patient counseling.

Keywords:
AgeFlow diverterIntracranial aneurysmOcclusionPipeline embolization deviceStentUnruptured

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