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Is Contrast Stasis After Pipeline Embolization Device Deployment Associated with Higher Aneurysm Occlusion Rates?
Kunal Vakharia1, Muhammad Waqas1, Stephan A Munich1
1Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
Insights
Immediate contrast stasis after Pipeline Embolization Device (PED) placement for intracranial aneurysms (IAs) does not predict long-term occlusion rates. This finding suggests other factors are more critical for successful IA treatment outcomes.
Area of Science:
- Neuroendovascular surgery
- Cerebrovascular diseases
- Medical device technology
Background:
- Intracranial aneurysms (IAs) pose significant risks, necessitating effective treatment strategies.
- The Pipeline Embolization Device (PED) is a common endovascular treatment for IAs.
- Assessing immediate post-deployment factors is crucial for predicting treatment success.
Purpose of the Study:
- To evaluate the relationship between immediate post-deployment contrast stasis in intracranial aneurysms (IAs) treated with the Pipeline Embolization Device (PED).
- To determine if the degree of contrast stasis correlates with 6- and 12-month angiographic occlusion rates.
- To identify potential predictors of successful IA occlusion after PED treatment.
Main Methods:
- Retrospective cohort study of patients undergoing PED deployment for saccular IA treatment.
- Angiographic grading of intra-aneurysmal contrast flow immediately after PED deployment (0-3 scale).
- Follow-up angiography at 6 and 12 months to assess occlusion rates.
Main Results:
- 119 patients with 141 aneurysms treated with 182 PEDs were analyzed.
- Immediate contrast stasis grades (0-3) were observed in 139 aneurysms.
- No statistically significant association was found between immediate contrast stasis grades and 6- or 12-month complete occlusion rates (P=0.60).
Conclusions:
- The degree of immediate contrast stasis following PED deployment does not statistically predict 6- and 12-month angiographic occlusion rates for intracranial aneurysms.
- Factors beyond immediate contrast flow appear to influence long-term treatment success.
- Further research may be needed to identify other predictive markers for successful PED treatment.
Objective:
To assess the association of degree of contrast stasis in intracranial aneurysms (IAs) immediately after Pipeline embolization device (PED; Medtronic, Dublin, Ireland) deployment with 6- and 12-month angiographic occlusion rates.
Methods:
This retrospective cohort study included consecutive patients undergoing PED deployment for saccular IA treatment at a large-volume cerebrovascular center over a 4-year 9-month period. Angiographic images obtained immediately after PED deployment were graded according to amount of intra-aneurysmal contrast flow during the late venous phase: 0 = no stasis; 1 = <50% contrast stasis; 2 = 50%-75% stasis; and 3 = >75%-99% stasis. Follow-up occlusion rates were determined by digital subtraction angiography, computed tomographic angiography, or magnetic resonance angiography.
Results:
The study included 119 patients in whom 182 PEDs were deployed to treat 141 aneurysms. A single PED was deployed in 105 (74.5%) aneurysms. The internal carotid artery was the commonest aneurysm site (119 [85%]). Fifty-two (36.9%) aneurysms were grade 0; 33 (23.4%) were grade 1; 46 (32.6%) were grade 2; and 10 (7.1%) were grade 3 immediately post-treatment. A 6-month follow-up angiogram available for 101 aneurysms showed complete occlusion (no flow into the aneurysm) in 74 (73.3%) aneurysms. A 12-month follow-up study available for 132 aneurysms showed complete occlusion in 79.5%. At last follow-up, occlusion rates were not significantly different for different contrast stasis grades (P = 0.60). Mean angiographic follow up for all IAs was 23v±v17.7 months. IA size, sex, age, and smoking were not significant predictors of occlusion.
Conclusions:
The degree of aneurysm contrast stasis immediately after PED deployment is not statistically associated with 6- and 12-month angiographic occlusion rates.
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