title: Flow diversion versus traditional aneurysm embolization strategies: analysis of fluoroscopy and procedure times.
abstract: OBJECTIVE
  Flow diverters are increasingly used for treatment of complex intracranial aneurysms. The purpose of this study was to compare the pipeline embolization device (PED) and traditional embolization strategies in terms of fluoroscopy and procedure time.
  
  
  METHODS
  Fluoroscopy and procedure times (in minutes) were retrospectively analyzed and compared between 127 patients treated with the PED, 86 patients treated with single stage stent assisted coiling (SAC), and 16 patients treated with Onyx HD 500 at our institution. A multivariate logistic regression analysis was performed to determine independent predictors of fluoroscopy and procedure time.
  
  
  RESULTS
  The three groups were comparable with respect to patient age, gender, and ruptured/unruptured aneurysm status. Aneurysms treated with the PED were significantly larger than stent coiled aneurysms, and aneurysm location distribution differed significantly between the three groups. Mean fluoroscopy time was significantly increased in the SAC (55±31 min, p<0.001) and Onyx HD 500 (91±36 min, p<0.001) groups relative to the PED group (34±23 min). Likewise, mean procedure time was significantly longer in SAC (155±50 min, p<0.001) and Onyx HD 500 (176±65 min, p<0.001) patients compared with PED patients (131±36 min). In multivariate analysis, SAC/Onyx HD 500 versus PED independently predicted longer procedure and fluoroscopy times.
  
  
  CONCLUSIONS
  PED treatment requires significantly shorter fluoroscopy and procedure times compared with SAC and Onyx HD 500. The results of this study may be used by advocates of flow diverters as an additional argument for using this treatment modality to treat intracranial aneurysms.
authors.affiliation: Department of Neurosurgery, Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: McMahon
authors.forename: Lea A
authors.initials: LA
authors.lastname: Moukarzel
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.forename: Eric L
authors.initials: EL
authors.lastname: Gingold
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005471:Fluoroscopy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D055815:Young Adult
keywords: Aneurysm