title: International retrospective study of the pipeline embolization device: a multicenter aneurysm treatment study.
abstract: OBJECTIVE
  Flow diverters are increasingly used in the endovascular treatment of intracranial aneurysms. Our aim was to determine neurologic complication rates following Pipeline Embolization Device placement for intracranial aneurysm treatment in a real-world setting.
  
  
  METHODS
  We retrospectively evaluated all patients with intracranial aneurysms treated with the Pipeline Embolization Device between July 2008 and February 2013 in 17 centers worldwide. We defined 4 subgroups: internal carotid artery aneurysms of ≥10 mm, ICA aneurysms of <10 mm, other anterior circulation aneurysms, and posterior circulation aneurysms. Neurologic complications included spontaneous rupture, intracranial hemorrhage, ischemic stroke, permanent cranial neuropathy, and mortality. Comparisons were made with t tests or ANOVAs for continuous variables and the Pearson χ(2) or Fisher exact test for categoric variables.
  
  
  RESULTS
  In total, 793 patients with 906 aneurysms were included. The neurologic morbidity and mortality rate was 8.4% (67/793), highest in the posterior circulation group (16.4%, 9/55) and lowest in the ICA <10-mm group (4.8%, 14/294) (P = .01). The spontaneous rupture rate was 0.6% (5/793). The intracranial hemorrhage rate was 2.4% (19/793). Ischemic stroke rates were 4.7% (37/793), highest in patients with posterior circulation aneurysms (7.3%, 4/55) and lowest in the ICA <10-mm group (2.7%, 8/294) (P = .16). Neurologic mortality was 3.8% (30/793), highest in the posterior circulation group (10.9%, 6/55) and lowest in the anterior circulation ICA <10-mm group (1.4%, 4/294) (P < .01).
  
  
  CONCLUSIONS
  Aneurysm treatment with the Pipeline Embolization Device is associated with the lowest complication rates when used to treat small ICA aneurysms. Procedure-related morbidity and mortality are higher in the treatment of posterior circulation and giant aneurysms.
authors.affiliation: From the Department of Radiology (D.F.K., W.B., G.L.), Mayo Clinic, Rochester, Minnesota Kallmes.david@mayo.edu.
authors.forename: D F
authors.initials: DF
authors.lastname: Kallmes
authors.affiliation: Department of Neurosurgery (R.H.), Mayo Clinic, Jacksonville, Florida.
authors.forename: R
authors.initials: R
authors.lastname: Hanel
authors.affiliation: Department of Neurological Surgery (D.L.), Rush University Medical Center, Chicago, Illinois.
authors.forename: D
authors.initials: D
authors.lastname: Lopes
authors.affiliation: Department of Neuroradiology (E.B.), Niguarda CA' Granda Hospital, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Boccardi
authors.affiliation: Department of Neuroradiology (A.B.), Hôpital Gui de Chauliac, Montpellier, France.
authors.forename: A
authors.initials: A
authors.lastname: Bonafé
authors.affiliation: Department of Radiology (S.C.), Hacettepe University Hospitals, Ankara, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Cekirge
authors.affiliation: Department of Neurological Surgery (D.F., H.W.), Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: D
authors.initials: D
authors.lastname: Fiorella
authors.affiliation: Department of Neurosurgery (P.J.), Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: P
authors.initials: P
authors.lastname: Jabbour
authors.affiliation: Department of Neurosurgery (E.L., A.S.), University at Buffalo, State University of New York, Buffalo, New York.
authors.forename: E
authors.initials: E
authors.lastname: Levy
authors.affiliation: Department of Neurosurgery (C.M., F.A.), Barrow Neurological Associates, Phoenix, Arizona.
authors.forename: C
authors.initials: C
authors.lastname: McDougall
authors.affiliation: Department of Neurosurgery (E.L., A.S.), University at Buffalo, State University of New York, Buffalo, New York.
authors.forename: A
authors.initials: A
authors.lastname: Siddiqui
authors.affiliation: National Institute of Neurosciences (I.S.), Budapest, Hungary.
authors.forename: I
authors.initials: I
authors.lastname: Szikora
authors.affiliation: Department of Neurological Surgery (D.F., H.W.), Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: H
authors.initials: H
authors.lastname: Woo
authors.affiliation: Department of Neurosurgery (C.M., F.A.), Barrow Neurological Associates, Phoenix, Arizona.
authors.forename: F
authors.initials: F
authors.lastname: Albuquerque
authors.affiliation: Department of Neurology (H.B.), Oregon Health and Science University, Portland, Oregon.
authors.forename: H
authors.initials: H
authors.lastname: Bozorgchami
authors.affiliation: Norton Neuroscience Institute (S.R.D.), Louisville, Kentucky.
authors.forename: S R
authors.initials: SR
authors.lastname: Dashti
authors.affiliation: Department of Radiology (J.E.D.A.), Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: J E
authors.initials: JE
authors.lastname: Delgado Almandoz
authors.affiliation: Division of Neurosurgery, Department of Surgery (M.E.K.), University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: M E
authors.initials: ME
authors.lastname: Kelly
authors.affiliation: Department of Neurosciences (R.T.), Medical University of South Carolina, Charleston, South Carolina.
authors.forename: R
authors.initials: R
authors.lastname: Turner
authors.affiliation: Vista Radiology PC (B.K.W.), Knoxville, Tennessee.
authors.forename: B K
authors.initials: BK
authors.lastname: Woodward
authors.affiliation: From the Department of Radiology (D.F.K., W.B., G.L.), Mayo Clinic, Rochester, Minnesota.
authors.forename: W
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: From the Department of Radiology (D.F.K., W.B., G.L.), Mayo Clinic, Rochester, Minnesota.
authors.forename: G
authors.initials: G
authors.lastname: Lanzino
authors.affiliation: Department of Neuroscience (P.L.), Equipo de Neurocirugía Endovascular Radiología Intervencionista, Buenos Aires, Argentina.
authors.forename: P
authors.initials: P
authors.lastname: Lylyk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies