title: Marked decrease in coil and stent utilization following introduction of flow diversion technology.
abstract: BACKGROUND
  Flow diversion represents a major paradigm shift in the treatment of unruptured intracranial aneurysms. The potential impact of this technique on coil utilization and adjunctive techniques such as balloon-assisted and stent-assisted coiling is unknown. In this study, the effect of introduction of flow diversion devices on the utilization of coil and adjunctive techniques was assessed.
  
  
  METHODS
  A retrospective review was conducted of consecutive patients with unruptured aneurysms treated at our institution comparing two groups: Group 1 (patients treated in the 2-year interval preceding the introduction of the Pipeline Embolization Device (PED) and Group 2 (patients treated during the 2-year interval following introduction in our practice of the PED).
  
  
  RESULTS
  Mean aneurysm diameter was 8.7 ± 6.3 mm in Group 1 and 8.5 ± 6.1 mm in Group 2 (p=0.79). PED therapy was employed in 38 (21.7%) of 175 aneurysms in Group 2. The proportion of stent-assisted procedures was significantly less in Group 2 than in Group 1 (6.9% vs 14.7%, p=0.04), as was the proportion of patients undergoing parent artery sacrifice (0.6% vs 3.9%, p=0.046). The mean and median number of coils used per aneurysm were 5.4 ± 3.6 and 5 (range 1-18) for Group 1 and 3.2 ± 3.2 and 3 (range 0-19) for Group 2 (p ≤ 0.0001).
  
  
  CONCLUSIONS
  Flow diversion represents a disruptive technology. More than one-fifth of unruptured aneurysms at our institution were treated with PED after introduction of this technology, resulting in marked decreases in coil and stent utilization.
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Crobeddu
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D004621:Embolization, Therapeutic / Q000379:methods / Q000706:statistics & numerical data*; D057510:Endovascular Procedures / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome