Pipeline Embolization Device Versus Stent-Assisted Coiling for Intracranial Aneurysm Treatment: A Retrospective Propensity Score-Matched Study.
BACKGROUND
Pipeline embolization device (PED; Medtronic) and stent-assisted coiling (SAC) are established modalities for treatment of intracranial aneurysms.


OBJECTIVE
To comparatively assess the efficacy of these techniques.


METHODS
We conducted a retrospective analysis of patients with aneurysms treated at our institution with either PED from 2013 to 2017 or SAC from 2009 to 2015. All large (>10 mm), ruptured, fusiform, anterior communicating artery, posterior circulation aneurysms, and patients with no available follow-up imaging were eliminated before running the propensity score matching (PSM). Patients were matched using nearest neighbor controlling for: age, gender, smoking, exact location, maximal diameter, and presence of multiple aneurysms. Total hospital costs for equipment and implants were calculated from procedure product and hospital billing records, and compared between the propensity-matched pairs.


RESULTS
Out of 165 patients harboring 202 aneurysms; 170 (84.2%) were treated with the PED, and 32 (15.8%) were treated using SAC. PSM resulted in 23 matched pairs; with significantly longer follow up in the SAC group (mean 29.8 vs 14.1 mo; P = .0002). Complete occlusion rates were not different (82.6 vs 87%; P = .68), with no difference between the groups for modified Rankin Scale on last clinical follow-up, procedural complications or retreatment rates. Average total costs calculated from the hospital records, including equipment and implants, were not different between propensity-score matched pairs (P = .48).


CONCLUSION
PED placement and SAC offer equally efficacious occlusion rates, functional outcomes, procedural complication rates, and cost profiles for small unruptured anterior circulation saccular aneurysms which do not involve the anterior communicating artery.
['Salem|Mohamed M|MM|', 'Ravindran|Krishnan|K|', 'Enriquez-Marulanda|Alejandro|A|', 'Ascanio|Luis C|LC|', 'Jordan|Noah|N|', 'Gomez-Paz|Santiago|S|', 'Foreman|Paul M|PM|', 'Ogilvy|Christopher S|CS|', 'Thomas|Ajith J|AJ|', 'Moore|Justin M|JM|']
D000328:Adult D000368:Aged D001807:Blood Vessel Prosthesis D004621:Embolization, Therapeutic D057510:Endovascular Procedures D005260:Female D006801:Humans D002532:Intracranial Aneurysm D008297:Male D008875:Middle Aged D057216:Propensity Score D012189:Retrospective Studies D015607:Stents D016896:Treatment Outcome
Pipeline embolization device Intracranial aneurysm Flow diversion Stent coiling