Pipeline Embolization Device and Pipeline Flex Versus Surpass Streamline Flow Diversion in Intracranial Aneurysms: A Retrospective Propensity Score–Matched Study

Chaim M. Feigen; Juan Vivanco-Suarez; Kainaat Javed; Joseph M. Dardick; Ryan Holland; Alan Mendez-Ruiz; Santiago Ortega-Gutierrez; Neil Haranhalli; David J. Altschul

doi:10.1016/j.wneu.2022.02.025

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Pipeline Embolization Device and Pipeline Flex Versus Surpass Streamline Flow Diversion in Intracranial Aneurysms: A Retrospective Propensity Score–Matched Study

Journal article

Peer reviewed

Pipeline Embolization Device and Pipeline Flex Versus Surpass Streamline Flow Diversion in Intracranial Aneurysms: A Retrospective Propensity Score–Matched Study

Chaim M. Feigen, Juan Vivanco-Suarez, Kainaat Javed, Joseph M. Dardick, Ryan Holland, Alan Mendez-Ruiz, Santiago Ortega-Gutierrez, Neil Haranhalli and David J. Altschul

World neurosurgery, Vol.161, pp.e384-e394

05/2022

DOI: 10.1016/j.wneu.2022.02.025

PMID: 35151920

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Abstract

To compare safety and efficacy profiles in aneurysms treated with Pipeline Embolization Device or Pipeline Flex versus Surpass Streamline flow diverters (FDs). Patients who underwent flow diversion for aneurysm treatment at 2 centers were included. Covariates comprised patient demographics, comorbidities, and aneurysm characteristics. Metrics included number of devices, adjuvant device use, case duration, and radiation exposure. Outcomes included periprocedural complications and radiographic results at follow-up. Propensity score-matched pairs were generated using demographic and aneurysm characteristics to verify the outcomes in equally sized groups. The majority of 141 flow diversion procedures performed on 126 patients were in the anterior circulation (96%) and unruptured (93%). Operators experienced more complications placing Surpass FDs compared with Pipelines (18.2% vs. 3.1%, P = 0.005) but used fewer Surpass devices per case (1 device in all Surpass cases and range for Pipeline cases 1–7; P < 0.001). Ballooning was more frequent for Surpass (29.5% vs. 2.1%, P < 0.001). There were no differences in mortality (2.1% vs. 0, P = 1.00), intracranial hemorrhage (3.1% vs. 0, P = 0.551), or stroke (4.2% vs. 6.8%, P = 0.680). Rates of aneurysm obliteration at follow-up were similar. Propensity-matched pairs had no differences in FD deployment complications or perioperative events, yet the significant differences remained for adjuvant balloon use and number of FDs deployed. While the devices demonstrated similar safety and efficacy profiles, deployment of the Surpass Streamline was more technically challenging than Pipeline Embolization Device or Pipeline Flex. Prospective cohort studies are needed to corroborate these findings.

Aneurysm

Flow diversion

Pipeline embolization

Stent

Stroke

Subarachnoid hemorrhage

Details

Title: Subtitle: Pipeline Embolization Device and Pipeline Flex Versus Surpass Streamline Flow Diversion in Intracranial Aneurysms: A Retrospective Propensity Score–Matched Study
Creators: Chaim M. Feigen - Montefiore Department of Neurological Surgery 3316 Rochambeau Avenue Bronx, NY 10467
Juan Vivanco-Suarez - University of Iowa Hospitals and Clinics
Kainaat Javed - Montefiore Medical Center
Joseph M. Dardick - Montefiore Medical Center
Ryan Holland - Montefiore Medical Center
Alan Mendez-Ruiz - University of Iowa
Santiago Ortega-Gutierrez - University of Iowa
Neil Haranhalli - Montefiore Medical Center
David J. Altschul - Montefiore Medical Center
Resource Type: Journal article
Publication Details: World neurosurgery, Vol.161, pp.e384-e394
DOI: 10.1016/j.wneu.2022.02.025
PMID: 35151920
NLM abbreviation: World Neurosurg
ISSN: 1878-8750
eISSN: 1878-8769
Publisher: Elsevier Inc
Language: English
Date published: 05/2022
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984302203402771

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