title: Intracranial aneurysms: midterm outcome of pipeline embolization device--a prospective study in 143 patients with 178 aneurysms.
abstract: OBJECTIVE
  To evaluate the midterm clinical and angiographic outcomes after pipeline embolization device (PED) placement for treatment of intracranial aneurysms.
  
  
  METHODS
  This prospective nonrandomized multicenter study was approved by the review boards of all involved centers; informed consent was obtained. Patients (143 patients, 178 aneurysms) with unruptured saccular or fusiform aneurysms or recurrent aneurysms after previous treatment were included and observed angiographically for up to 18 months and clinically for up to 3 years. Study endpoints included complete aneurysm occlusion; neurologic complications within 30 days and up to 3 years; clinical outcome of cranial nerve palsy after PED placement; angiographic evidence of occlusion or stenosis of parent artery and that of occlusion of covered side branches at 6, 12, and 18 months; and clinical and computed tomographic evidence of perforator infarction.
  
  
  RESULTS
  There were five (3.5%) cases of periprocedural death or major stroke (modified Rankin Scale [mRS] > 3) (95% confidence interval [CI]: 1.3%, 8.4%), including two posttreatment delayed ruptures, two intracerebral hemorrhages, and one thromboembolism. Five (3.5%) patients had minor neurologic complications within 30 days (mRS = 1) (95% CI: 1.3%, 8.4%), including transient ischemic attack (n = 2), small cerebral infarction (n = 2), and cranial nerve palsy (n = 1). Beyond 30 days, there was one fatal intracerebral hemorrhage and one transient ischemic attack. Ten of 13 patients (95% CI: 46%, 93.8%) completely recovered from symptoms of cranial nerve palsy within a median of 3.5 months. Angiographic results at 18 months revealed a complete aneurysm occlusion rate of 84% (49 of 58; 95% CI: 72.1%, 92.2%), with no cases of parent artery occlusion, parent artery stenosis (<50%) in three patients, and occlusion of a covered side branch in two cases (posterior communicating arteries). Perforator infarction did not occur.
  
  
  CONCLUSIONS
  PED placement is a reasonably safe and effective treatment for intracranial aneurysms. The treatment is promising for aneurysms of unfavorable morphologic features, such as wide neck, large size, fusiform morphology, incorporation of side branches, and posttreatment recanalization, and should be considered a first choice for treating unruptured aneurysms and recurrent aneurysms after previous treatments.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120422/-/DC1.
authors.affiliation: Department of Imaging and Interventional Radiology and Division of Neurosurgery, Department of Surgery, the Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Room 2A061, 2/F, New Extension Block, Shatin, New Territories, Hong Kong. simonyu@cuhk.edu.hk
authors.forename: Simon Chun-Ho
authors.initials: SC
authors.lastname: Yu
authors.forename: Ching-Kwong
authors.initials: CK
authors.lastname: Kwok
authors.forename: Pui-Wai
authors.initials: PW
authors.lastname: Cheng
authors.forename: Kwong-Yau
authors.initials: KY
authors.lastname: Chan
authors.forename: Samuel Shun
authors.initials: SS
authors.lastname: Lau
authors.forename: Wai-Man
authors.initials: WM
authors.lastname: Lui
authors.forename: Ka-Ming
authors.initials: KM
authors.lastname: Leung
authors.forename: Raymand
authors.initials: R
authors.lastname: Lee
authors.forename: Harold Kin-Ming
authors.initials: HK
authors.lastname: Cheng
authors.forename: Yuk-Ling
authors.initials: YL
authors.lastname: Cheung
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Chan
authors.forename: George Kwok-Chu
authors.initials: GK
authors.lastname: Wong
authors.forename: Joyce Wai-Yi
authors.initials: JW
authors.lastname: Hui
authors.forename: Yiu-Chung
authors.initials: YC
authors.lastname: Wong
authors.forename: Chong-Boon
authors.initials: CB
authors.lastname: Tan
authors.forename: Wai-Lun
authors.initials: WL
authors.lastname: Poon
authors.forename: Kai-Yuen
authors.initials: KY
authors.lastname: Pang
authors.forename: Alain Kai-Sing
authors.initials: AK
authors.lastname: Wong
authors.forename: Kai-Hung
authors.initials: KH
authors.lastname: Fung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D016009:Chi-Square Distribution; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome