Journal article
The Pipeline Embolization Device: Learning Curve and Predictors of Complications and Aneurysm Obliteration
Neurosurgery, Vol.73(1), pp.113-120
07/2013
DOI: 10.1227/01.neu.0000429844.06955.39
PMID: 23615106
Abstract
BACKGROUND:The Pipeline Embolization Device (PED) has emerged as a promising treatment for intracranial aneurysms.\nOBJECTIVE:To assess the safety and efficacy of the PED, to analyze the effect of operator experience on the complication rate, and to identify predictors of complications and obliteration.\nMETHODS:A total of 109 patients with 120 aneurysms were treated with PED at our institution. The patient population was divided into 3 consecutive equal groups to assess whether overall and major complication rates decreased over timegroup 1, patients 1 through 37; group 2, patients 38 through 73; and group 3, patients 74 through 109.\nRESULTS:The number of PEDs used was 1.40 per aneurysm. Symptomatic and major procedure-related complications occurred in 11% and 3.7% of patients, respectively. The rate of complications decreased from 16.2% in group 1 to 5.6% in group 3, and the rate of major complications fell dramatically from 10.8% in group 1 to 0% in groups 2 and 3 (P < .05). Procedure time significantly decreased over time (P = .04). In multivariate analysis, previously treated aneurysms were predictive of procedural complications (P = .02). At the latest follow-up, 65.8% of aneurysms were completely occluded, 9.6% were nearly completely occluded, and 24.6% were incompletely occluded. In multivariate analysis, fusiform aneurysms (P = .05) and shorter angiographic follow-up (P = .03) were negative predictors of aneurysm obliteration.\nCONCLUSION:PED therapy may have an acceptable safety-efficacy profile. The risk of complications appears to decrease dramatically with physician experience, supporting the existence of a learning curve. Patients with previously treated aneurysms have higher complication rates, whereas fusiform aneurysms achieve lower obliteration rates.\nABBREVIATIONS:OR, odds ratioPED, Pipeline Embolization Device
Details
- Title: Subtitle
- The Pipeline Embolization Device: Learning Curve and Predictors of Complications and Aneurysm Obliteration
- Creators
- Pascal Jabbour - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; ‡Department of Neurosurgery, University of Iowa, Iowa City, IowaNohra ChalouhiStavropoula TjoumakarisL. Fernando GonzalezAaron S DumontCiro RandazzoRobert StarkeDavid HasanRohan ChitaleSaurabh SinghalLea MoukarzelRobert Rosenwasser
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.73(1), pp.113-120
- DOI
- 10.1227/01.neu.0000429844.06955.39
- PMID
- 23615106
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Language
- English
- Date published
- 07/2013
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurosurgery; Otolaryngology
- Record Identifier
- 9984040283502771
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