title: Extending the indications of flow diversion to small, unruptured, saccular aneurysms of the anterior circulation.
abstract: OBJECTIVE
  Flow diverters are currently indicated for treatment of large and complex intracranial aneurysms. The purpose of this study was to determine whether the indications of flow diversion can be safely extended to unruptured, small, saccular aneurysms (<10 mm) of the anterior circulation.
  
  
  METHODS
  Forty patients treated with the pipeline embolization device (PED) were matched in a 1:4 fashion with 160 patients treated with stent-assisted coiling based on patient age, sex, aneurysm location, and aneurysm size. Procedural complications, angiographic results, and clinical outcomes were analyzed and compared.
  
  
  RESULTS
  The rate of periprocedural complications was 5% in the PED group and 3% in the stent-coil group (P=0.7). In multivariable analysis, increasing age was the only predictor of complications. At follow-up, a higher proportion of aneurysms treated with PED (80%) achieved complete obliteration compared with stent-coiled aneurysms (70%) but the difference did not reach statistical significance (P=0.2). In multivariable analysis, increasing aneurysm size and aneurysm location were predictors of nonocclusion. The rate of favorable outcome (modified Rankin Scale, 0-2 and modified Rankin Scale, 0-1) was similar in the PED group and the coil group.
  
  
  CONCLUSIONS
  The PED was associated with similar periprocedural risks, clinical outcomes, and angiographic results compared with stent-assisted coiling. These findings suggest that the indications of PED can be safely extended to small intracranial aneurysms that are amenable to conventional endovascular techniques. Larger studies with long-term follow-up are necessary to determine the optimal treatment that leads to the highest rate of obliteration and best clinical outcomes.
authors.affiliation: From the Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA (N.C., R.M.S., S.Y., C.D.B., S.T., L.F.G., R.R., P.J.); and Department of Neurosurgery, University of Iowa, Iowa City, IA (D.H.).
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Steven
authors.initials: S
authors.lastname: Yang
authors.forename: Cory D
authors.initials: CD
authors.lastname: Bovenzi
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology*; D000077144:Clopidogrel; D016208:Databases, Factual; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: aneurysm; stents