Journal article
Predictors of Complications, Functional Outcome, and Morbidity in a Large Cohort Treated With Flow Diversion
Neurosurgery, Vol.87(4), pp.730-743
10/01/2020
DOI: 10.1093/neuros/nyz508
PMID: 31858148
Abstract
BACKGROUND: A dramatic improvement in obliteration rates of large, wide-necked aneurysms has been observed after the FDA approved the Pipeline Embolization Device (PED) in 2011.
OBJECTIVE: To assess the predictors of complications, morbidity, and unfavorable outcomes in a large cohort of patients with aneurysms treated with PED.
METHODS: A retrospective chart review of a prospectively maintained database for subjects treated with flow diversion from 2010 to 2019.
RESULTS: A total of 598 aneurysms were treated during a period extending from 2010 to 2019 (84.28% females, mean age 55.5 yr, average aneurysm size 8.49 mm). Morbidity occurred at a rate of 5.8% and mortality at a rate of 2.2%. Ischemic stroke occurred at a rate of 3%, delayed aneurysmal rupture (DAR) at 12%, and distal intraparenchymal hemorrhage (DIPH) at 1.5%. On multivariate analysis, the predictor of stroke was aneurysm size >15 mm. Predictors of DAR were previous subarachnoid hemorrhage (SAH), increasing aneurysm size, and posterior circulation aneurysm. Predictors of DIPH were using more than 1 PED and baseline P2Y12 value. Predictors of in-stent stenosis were the increasing year of treatment and balloon angioplasty, whereas increasing age and previous treatment were negatively associated with in-stent stenosis. Predictors of morbidity were posterior circulation aneurysms, increasing aneurysm size, and hypertension, and incidental aneurysm diagnosis was protective for morbidity.
CONCLUSION: Flow diversion is a safe and effective treatment option for aneurysms. A better understanding of predictive factors of complications, morbidity, and functional outcomes is of high importance for a more accurate risk assessment.
Details
- Title: Subtitle
- Predictors of Complications, Functional Outcome, and Morbidity in a Large Cohort Treated With Flow Diversion
- Creators
- Ahmad Sweid - Thomas Jefferson UniversityRobert M. Starke - University of MiamiNabeel Herial - Thomas Jefferson UniversityNohra Chalouhi - Thomas Jefferson UniversitySomnath Das - Thomas Jefferson UniversityMichael P. Baldassari - Thomas Jefferson UniversityTyler D. Alexander - Thomas Jefferson UniversityStavropoula Tjoumakaris - Thomas Jefferson UniversityM. Reid Gooch - Thomas Jefferson UniversityDavid Hasan - University of IowaRobert H. Rosenwasser - Thomas Jefferson UniversityVictor Romo - Thomas Jefferson UniversityPascal Jabbour - Thomas Jefferson University
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.87(4), pp.730-743
- Publisher
- Oxford Univ Press
- DOI
- 10.1093/neuros/nyz508
- PMID
- 31858148
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Number of pages
- 14
- Language
- English
- Date published
- 10/01/2020
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering
- Record Identifier
- 9984419107802771
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