title: Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms.
abstract: OBJECTIVE
  Flow diversion has emerged as an important tool for the management of intracranial aneurysms. The purpose of this study was to compare flow diversion and traditional embolization strategies in terms of safety, efficacy, and clinical outcomes in patients with unruptured, large saccular aneurysms (≥10 mm).
  
  
  METHODS
  Forty patients treated with the Pipeline Embolization Device (PED) were matched in a 1:3 fashion with 120 patients treated with coiling based on patient age and aneurysm size. Fusiform and anterior communicating artery aneurysms were eliminated from the analysis. Procedural complications, angiographic results, and clinical outcomes were analyzed and compared.
  
  
  RESULTS
  There were no differences between the 2 groups in terms of patient age, sex, aneurysm size, and aneurysm location. The rate of procedure-related complications did not differ between the PED (7.5%) and the coil group (7.5%; P=1). At the latest follow-up, a significantly higher proportion of aneurysms treated with PED (86%) achieved complete obliteration compared with coiled aneurysms (41%; P<0.001). In multivariable analysis, coiling was an independent predictor of nonocclusion. Retreatment was necessary in fewer patients in the PED group (2.8%) than the coil group (37%; P<0.001). A similar proportion of patients attained a favorable outcome (modified Rankin Scale, 0-2) in the PED group (92%) and in the coil group (94%; P=0.8).
  
  
  CONCLUSIONS
  The PED provides higher aneurysm occlusion rates than coiling, with no additional morbidity and similar clinical outcomes. These findings suggest that the PED might be a preferred treatment option for large unruptured saccular aneurysms.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA 19107, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Ciro
authors.initials: C
authors.lastname: Randazzo
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: McMahon
authors.forename: Saurabh
authors.initials: S
authors.lastname: Singhal
authors.forename: Lea A
authors.initials: LA
authors.lastname: Moukarzel
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D004864:Equipment and Supplies / Q000009:adverse effects / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology; D015607:Stents; D016896:Treatment Outcome
keywords: aneurysm; coils; flow diverter; pipeline embolization device