title: Long-Term Follow-Up Results following Elective Treatment of Unruptured Intracranial Aneurysms with the Pipeline Embolization Device.
abstract: OBJECTIVE
  Numerous reports of treatment of wide-neck aneurysms by flow diverters have been published; however, long-term outcomes remain uncertain. This article reports the imaging results of unruptured aneurysms treated electively with the Pipeline Embolization Device for up to 56 months and clinical results for up to 61 months.
  
  
  METHODS
  One hundred nineteen aneurysms in 98 patients from 3 centers admitted between August 2009 and June 2011 were followed at 6-month, 1-year, and 2+-year postprocedural timeframes. Analyses on the effects of incorporated vessels, previous stent placement, aneurysm size, and morphology on aneurysm occlusion were performed.
  
  
  RESULTS
  The 1- and 2+-year imaging follow-ups were performed, on average, 13 and 28 months postprocedure. At 2+-year follow-up, clinical data were 100% complete and imaging data were complete for 103/116 aneurysms (88.8%) with a 93.2% occlusion rate. From 0 to 6 months, TIA, minor stroke, and major stroke rates were 4.2%, 3.4%, and 0.8% respectively. After 6 months, 1 patient had a TIA of uncertain cause, with an overall Pipeline Embolization Device-related mortality rate of 0.8%. An incorporated vessel was significant for a delay in occlusion (P = .009) and nonocclusion at 6 months and 1 year, with a delayed mean time of occlusion from 9.1 months (95% CI, 7.1-11.1 months) to 16.7 months (95% CI, 11.4-22.0 months). Other factors were nonsignificant.
  
  
  CONCLUSIONS
  The Pipeline Embolization Device demonstrates continued very high closure rates at 2+ years, with few delayed clinical adverse sequelae. The presence of an incorporated vessel in the wall of the aneurysm causes a delay in occlusion that approaches sidewall closure rates by 2 years.
authors.affiliation: From the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia albert.h.chiu@gmail.com.
authors.forename: A H Y
authors.initials: AH
authors.lastname: Chiu
authors.affiliation: From the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia Prince of Wales and Liverpool Hospitals (A.K.C., J.D.W.), Sydney, Australia.
authors.forename: A K
authors.initials: AK
authors.lastname: Cheung
authors.affiliation: Prince of Wales and Liverpool Hospitals (A.K.C., J.D.W.), Sydney, Australia.
authors.forename: J D
authors.initials: JD
authors.lastname: Wenderoth
authors.affiliation: Gold Coast University Hospital (L.D.V., H.R.), Gold Coast, Australia.
authors.forename: L
authors.initials: L
authors.lastname: De Villiers
authors.affiliation: Gold Coast University Hospital (L.D.V., H.R.), Gold Coast, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Rice
authors.affiliation: From the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia.
authors.forename: C C
authors.initials: CC
authors.lastname: Phatouros
authors.affiliation: From the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia.
authors.forename: T P
authors.initials: TP
authors.lastname: Singh
authors.affiliation: From the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia.
authors.forename: T J
authors.initials: TJ
authors.lastname: Phillips
authors.affiliation: From the Neurological Intervention and Imaging Service (Western Australia) (A.H.Y.C., A.K.C., C.C.P., T.P.S., T.J.P., W.M.), Perth, Australia.
authors.forename: W
authors.initials: W
authors.lastname: McAuliffe
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome