Comparison of Flow Diversion and Coiling in Large Unruptured Intracranial Saccular Aneurysms

Nohra CHALOUHI; Stavropoula TJOUMAKARIS; Robert ROSENWASSER; Pascal JABBOUR; Robert M STARKE; L. Fernando GONZALEZ; Ciro RANDAZZO; David HASAN; Jeffrey F MCMAHON; Saurabh SINGHAL; Lea A MOUKARZEL; Aaron S DUMONT

doi:10.1161/STROKEAHA.113.001785

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Comparison of Flow Diversion and Coiling in Large Unruptured Intracranial Saccular Aneurysms

Journal article

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Comparison of Flow Diversion and Coiling in Large Unruptured Intracranial Saccular Aneurysms

Nohra CHALOUHI, Stavropoula TJOUMAKARIS, Robert ROSENWASSER, Pascal JABBOUR, Robert M STARKE, L. Fernando GONZALEZ, Ciro RANDAZZO, David HASAN, Jeffrey F MCMAHON, Saurabh SINGHAL, …

Stroke (1970), Vol.44(8), pp.2150-2154

2013

DOI: 10.1161/STROKEAHA.113.001785

PMID: 23723311

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Abstract

Background and purpose: Flow diversion has emerged as an important tool for the management of intracranial aneurysms. The purpose of this study was to compare flow diversion and traditional embolization strategies in terms of safety, efficacy, and clinical outcomes in patients with unruptured, large saccular aneurysms (≥10 mm). Methods: Forty patients treated with the Pipeline Embolization Device (PED) were matched in a 1:3 fashion with 120 patients treated with coiling based on patient age and aneurysm size. Fusiform and anterior communicating artery aneurysms were eliminated from the analysis. Procedural complications, angiographic results, and clinical outcomes were analyzed and compared. Results: There were no differences between the 2 groups in terms of patient age, sex, aneurysm size, and aneurysm location. The rate of procedure-related complications did not differ between the PED (7.5%) and the coil group (7.5%; P=1). At the latest follow-up, a significantly higher proportion of aneurysms treated with PED (86%) achieved complete obliteration compared with coiled aneurysms (41%; P<0.001). In multivariable analysis, coiling was an independent predictor of nonocclusion. Retreatment was necessary in fewer patients in the PED group (2.8%) than the coil group (37%; P<0.001). A similar proportion of patients attained a favorable outcome (modified Rankin Scale, 0-2) in the PED group (92%) and in the coil group (94%; P=0.8). Conclusions: The PED provides higher aneurysm occlusion rates than coiling, with no additional morbidity and similar clinical outcomes. These findings suggest that the PED might be a preferred treatment option for large unruptured saccular aneurysms.

Neurology

Biological and medical sciences

Vascular diseases and vascular malformations of the nervous system

Medical sciences

Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)

Diseases of the nervous system

Details

Title: Subtitle: Comparison of Flow Diversion and Coiling in Large Unruptured Intracranial Saccular Aneurysms
Creators: Nohra CHALOUHI - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
Stavropoula TJOUMAKARIS - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
Robert ROSENWASSER - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
Pascal JABBOUR - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
Robert M STARKE - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
L. Fernando GONZALEZ - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
Ciro RANDAZZO - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
David HASAN - Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
Jeffrey F MCMAHON - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
Saurabh SINGHAL - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
Lea A MOUKARZEL - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
Aaron S DUMONT - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
Resource Type: Journal article
Publication Details: Stroke (1970), Vol.44(8), pp.2150-2154
DOI: 10.1161/STROKEAHA.113.001785
PMID: 23723311
NLM abbreviation: Stroke
ISSN: 0039-2499
eISSN: 1524-4628
Publisher: Lippincott Williams & Wilkins; Hagerstown, MD
Language: English
Date published: 2013
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Neurosurgery; Otolaryngology
Record Identifier: 9984040398502771

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