A single pipeline embolization device is sufficient for treatment of intracranial aneurysms.
OBJECTIVE
The Pipeline Embolization Device has emerged as an important treatment option for intracranial aneurysms. The number of devices needed to treat an aneurysm is uncertain and is the subject of vigorous debate. The purpose of this study was to compare rates of complications, aneurysm occlusion, and outcome in patients treated with a single-versus-multiple Pipeline Embolization Devices.


METHODS
One hundred seventy-eight patients were treated with the Pipeline Embolization Device at our institution. Patients were divided into 2 groups: a single-device group (n = 126) and a multiple-device group (n = 52).


RESULTS
There was no statistically significant difference between the 2 groups with respect to baseline characteristics except for age and aneurysm size (higher with multiple Pipeline Embolization Devices). Complications occurred more frequently with multiple (15%) versus a single device (5%, P = .03). In multivariate analysis, the use of multiple devices independently predicted complications. A similar proportion of patients achieved adequate aneurysm obliteration at follow-up in the single-device (84%) and the multiple-device groups (87%, P = .8). In multivariate analysis, age and follow-up time predicted obliteration. At follow-up, a significantly higher proportion of patients treated with a single device (97%) achieved a favorable outcome compared with those treated with multiple devices (89%, P = .03). In multivariate analysis, there was a strong trend for the use of a single device to predict favorable outcomes (P = .06).


CONCLUSIONS
Treatment with a single Pipeline Embolization Device provides similar occlusion rates with less complications and better overall outcomes. These findings suggest that a single Pipeline Embolization Device is sufficient for treatment of most intracranial aneurysms.
From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
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Chalouhi
From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
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Tjoumakaris
From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
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Phillips
From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
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Starke
Department of Neurosurgery (D.H.), University of Iowa, Iowa City, Iowa.
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Hasan
From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
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Wu
From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
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Zanaty
From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
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Kung
From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
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Gonzalez
From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
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Rosenwasser
From the Department of Neurosurgery (N.C., S.T., J.L.H.P., R.M.S., C.W., M.Z., D.K., L.F.G., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania pascal.jabbour@jefferson.edu.
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Jabbour
D000328:Adult; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016896:Treatment Outcome