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Analyzing the safety and efficacy of pipeline embolization device in pediatric aneurysms: insight from a mul-ticenter
Yang Zhao1,2, Junlin Lu3, Zhipeng Li1
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
Insights
The Pipeline Embolization Device (PED) shows effectiveness in treating pediatric aneurysms. However, substantial morbidity and mortality risks exist, necessitating careful clinical judgment for treatment timing in young patients.
Area of Science:
- Neuroendovascular Surgery
- Pediatric Neurosurgery
- Vascular Neurology
Background:
- Pediatric intracranial aneurysms pose significant risks, including spontaneous subarachnoid hemorrhage.
- The Pipeline Embolization Device (PED), approved for adults, is being explored for pediatric use due to its efficacy.
- This study evaluates the safety and effectiveness of PEDs in treating pediatric aneurysms.
Purpose of the Study:
- To assess the safety and effectiveness of the Pipeline Embolization Device (PED) for treating intracranial aneurysms in pediatric patients.
- To analyze clinical outcomes and complications associated with PED treatment in patients aged 18 years and younger.
Main Methods:
- A retrospective analysis of 25 pediatric patients (≤18 years) treated with PED across 14 institutions (2014-2019).
- A comprehensive literature review of published pediatric aneurysm cases treated with PED (2007-2023).
- Data analysis included demographics, aneurysm characteristics, treatment details, clinical outcomes, and complications.
Main Results:
- An 81-patient cohort (25 registry, 56 literature) with a mean age of 11.9 years was analyzed.
- High rates of large/giant aneurysms (53.1%) and a 87.7% occlusion rate were observed.
- Complications occurred in 12.3% of patients, with morbidity in 6.1% and mortality in 4.9%; age was not a significant factor.
Conclusions:
- The Pipeline Embolization Device (PED) demonstrates effectiveness in pediatric aneurysm treatment.
- Morbidity and mortality rates associated with PED use in children are substantial compared to adults.
- Treatment timing should be guided by clinical judgment and patient-specific factors, avoiding age-based delays.
Background:
Pediatric patients with intracranial aneurysms face high risks of spontaneous subarachnoid hemorrhages. Despite its approval for adults aged 22 and above, the Pipeline Embolization Device (PED, Covidien/Medtronic, Irvine, California, USA) is being considered for younger patients due to its efficacy. This study aims to assess the safety and effectiveness of using PEDs in pediatric aneurysm treatment.
Methods:
A retrospective study across 14 institutions identified 25 patients (age ≤ 18) treated with PED from November 2014 to October 2019. A literature review included all published pediatric aneurysm cases treated with PED from 2007 to 2023. Analyzed data included patient demographics, aneurysm characteristics, treatment, clinical outcomes, and complications.
Results:
We analyzed 81 pediatric patients, including 25 from the multi-center registry and 56 from 38 relevant literature. In the entire cohort of 81 patients, mean age of the patients was 11.9 ± 4.0 years (ranged from 9 months to 18 years), with 58.0% males. Ruptured aneurysms were observed in 7 patients (8.6%), whereas 43 patients (53.1%) harbored large/giant aneurysms. The aneurysm occlusion rate was 87.7% during the median 7 months follow-up. Complications occurred in 12.3% of patients, resulting in morbidity in 5 cases (6.1%) and mortality in 4 cases (4.9%). Patient age was not associated with the occurrence of aneurysm residual, complications, and mortality following PED treatment.
Conclusions:
PED can be effective for pediatric aneurysms, but morbidity and mortality can be substantial compared to the adults. Surgical timing should depend on clinical judgment and patient factors, without age-related delays.
