Efficacy and safety of adjunctive coiling in pipeline embolization device implantation for small and medium-sized unruptured cerebral aneurysms: a retrospective cohort study and literature review.
{"title":"Efficacy and safety of adjunctive coiling in pipeline embolization device implantation for small and medium-sized unruptured cerebral aneurysms: a retrospective cohort study and literature review.","authors":"Michiyasu Fuga, Toshihiro Ishibashi, Issei Kan, Rintaro Tachi, Ken Aoki, Naoki Kato, Shunsuke Hataoka, Gota Nagayama, Tohru Sano, Kazufumi Horiuchi, Hiroyuki Enomoto, Kazutaka Shirokane, Yuichi Murayama","doi":"10.1016/j.wneu.2025.123933","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The pipeline embolization device (PED) with adjunctive coiling (PAC) for small and medium-sized unruptured cerebral aneurysms (UCAs) has not yet been fully evaluated for promoting aneurysm occlusion and preventing delayed rupture. The present study investigated the efficacy and safety of the PAC for UCAs ≤10 mm in diameter.</p><p><strong>Methods: </strong>Fifty consecutive UCAs (50 patients) ≤10 mm in diameter that underwent flow diversion with a single PED at three institutions between January 2019 to January 2024 were retrospectively reviewed. Patients were divided into PAC (n=23) and PED-alone (n=27) groups. Data were compared regarding embolization results and complications.</p><p><strong>Results: </strong>Aneurysms with bleb formation, medium-sized aneurysms (7-10 mm), and those treated via transfemoral access were significantly more frequently managed with PAC than PED-alone. In the PAC group, Raymond-Roy Occlusion Classification scores immediately after treatment were Class 1 in one case (4.3%) and Class 3 in 22 cases (96%), with a mean volume embolization ratio of 20.6%. The PAC group had a significantly longer procedure time (184 vs. 117 minutes, P < .001) but showed no differences in ischemic or hemorrhagic complications, access site complications, or in-stent stenosis. Complete occlusion was significantly higher in the PAC group at 6 months (100% vs. 67%, P = .002) and 1 year (100% vs. 74%, P = .011). No delayed complications, including ischemic events, aneurysm rupture, or death, were observed in either group.</p><p><strong>Conclusions: </strong>PAC for UCAs ≤10 mm in diameter may enhance the rate of complete occlusion without increasing the risk of complications.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123933"},"PeriodicalIF":1.9000,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2025.123933","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The pipeline embolization device (PED) with adjunctive coiling (PAC) for small and medium-sized unruptured cerebral aneurysms (UCAs) has not yet been fully evaluated for promoting aneurysm occlusion and preventing delayed rupture. The present study investigated the efficacy and safety of the PAC for UCAs ≤10 mm in diameter.
Methods: Fifty consecutive UCAs (50 patients) ≤10 mm in diameter that underwent flow diversion with a single PED at three institutions between January 2019 to January 2024 were retrospectively reviewed. Patients were divided into PAC (n=23) and PED-alone (n=27) groups. Data were compared regarding embolization results and complications.
Results: Aneurysms with bleb formation, medium-sized aneurysms (7-10 mm), and those treated via transfemoral access were significantly more frequently managed with PAC than PED-alone. In the PAC group, Raymond-Roy Occlusion Classification scores immediately after treatment were Class 1 in one case (4.3%) and Class 3 in 22 cases (96%), with a mean volume embolization ratio of 20.6%. The PAC group had a significantly longer procedure time (184 vs. 117 minutes, P < .001) but showed no differences in ischemic or hemorrhagic complications, access site complications, or in-stent stenosis. Complete occlusion was significantly higher in the PAC group at 6 months (100% vs. 67%, P = .002) and 1 year (100% vs. 74%, P = .011). No delayed complications, including ischemic events, aneurysm rupture, or death, were observed in either group.
Conclusions: PAC for UCAs ≤10 mm in diameter may enhance the rate of complete occlusion without increasing the risk of complications.
期刊介绍：
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
