title: Use of coils in conjunction with the pipeline embolization device for treatment of intracranial aneurysms.
abstract: BACKGROUND
  Coiling in conjunction with Pipeline embolization device (PED) placement could provide immediate dome protection and an intraaneurysmal scaffold to prevent device prolapse for intracranial aneurysms with high rupture risk and complex anatomy.
  
  
  OBJECTIVE
  To report results after treatment of aneurysms with PED with coils (PED+coils group) or without (PED-only group) at a single-institution.
  
  
  METHODS
  In this case-controlled study, records of patients who underwent PED treatment between 2011 and 2013 were retrospectively reviewed.
  
  
  RESULTS
  Twenty-nine patients were treated with PED+coils and 75 with PED-only. No statistically significant between-group differences were found in terms of age, sex, aneurysm location, medical comorbidities, and length of follow-up. Aneurysms treated by PED+coils were larger (16.3 mm vs 12.4 mm, P=.02) and more likely to be ruptured (20.7% vs 1.3%, P=.001) or dissecting (34.5% vs 9.3%, P=.002). PED deployment was successful in all cases. At the latest follow-up (mean, 7.8 months), complete aneurysm occlusion was achieved in a higher proportion of the PED+coils group (93.1% vs 74.7%, P=.03). Device foreshortening/migration occurred in 4 patients in the PED-only group and none in the PED+coils group. Fewer patients required retreatment in the PED+coils group (3.4% vs 16.0%, P=.71). Rates of neurological complications (10.3% PED+coils vs 8.0% PED-only, P=.7) and favorable outcome (modified Rankin Scale score=0-2; 93.1% PED+coils vs 94.7% PED-only, P=.6) were similar.
  
  
  CONCLUSIONS
  PED+coils may be a safe and effective treatment for aneurysms with high risk of rupture (or rerupture) and complex anatomy. Coiling in conjunction with PED placement provided a higher aneurysm occlusion rate and reduced the need for retreatment.
authors.affiliation: *Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ‡Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, New York; §Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ¶Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ‖Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; #Jacobs Institute, Buffalo, New York.
authors.forename: Ning
authors.initials: N
authors.lastname: Lin
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brouillard
authors.forename: Chandan
authors.initials: C
authors.lastname: Krishna
authors.forename: Maxim
authors.initials: M
authors.lastname: Mokin
authors.forename: Sabareesh K
authors.initials: SK
authors.lastname: Natarajan
authors.forename: Ashish
authors.initials: A
authors.lastname: Sonig
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D016022:Case-Control Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods*; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome