Midterm outcomes and costs of Pipeline embolization device alone versus Atlas stent-assisted coiling for unruptured anterior circulation aneurysms: a propensity score matched comparative analysis.

Abstract

Background: Endovascular treatment has achieved great progress over the past few decades, providing multiple options for the treatment of intracranial aneurysms (IAs). In the present era of flow diverters (FDs), the optimum endovascular management for unruptured IAs amenable to both stent-assisted coiling (SAC) and FDs remains to be determined. Therefore, our study aimed to compare the midterm outcomes and costs of Pipeline embolization device (PED) alone versus Atlas SAC for the treatment of unruptured saccular anterior circulation aneurysms.

Methods: This is a retrospective cohort study in which we studied consecutive unruptured anterior circulation aneurysms treated with PED alone or Atlas SAC at our institution. Propensity score matching (PSM) was performed to control for potential differences.

Results: A total of 731 patients with 739 aneurysms were included: 299 patients with 302 aneurysms received PED treatment and 432 patients with 437 aneurysms received Atlas SAC treatment. The two groups differed at baseline. After PSM, two comparable groups of 192 aneurysms each were obtained. The PED alone group had shorter procedure times (97.65±33.53 vs. 125.17±30.71 min, P<0.001), and higher total hospital costs ($31,322.84±3,567.04 vs. $27,595.79±6,825.05, P<0.001) than the Atlas SAC group. The use of Atlas SAC reduced hospital costs by 13.5% compared to PED alone. At follow-up, the PED alone group was more prone to develop in-stent stenosis (ISS) compared to the Atlas SAC group (4.2% vs. 0.5%, P=0.043). The retreatment rate was higher in the Atlas group than in the PED group (4.7% vs. 0%, P=0.007). However, the complete aneurysm occlusion rates, favorable neurological and follow-up costs were similar in both groups.

Conclusions: This study showed similar midterm outcome with PED alone and Atlas SAC for the treatment of unruptured anterior circulation aneurysms. Atlas SAC required a longer procedure time, and PED alone increased hospital costs. However, patients who underwent PED treatment were more likely to develop ISS during follow-up. In addition, the retreatment rate was higher in the Atlas group than in the PED group.