Subgroup analysis of pipeline Flow-Diverter devices in the treatment of intracranial aneurysms: A long-term real-world study involving 190 patients.

Abstract

The Pipeline is currently the most widely used flow-diverting device worldwide, yet research on its long-term efficacy remains limited, primarily based on small to medium-sized sample cohorts. The objective of this study was to evaluate the long-term safety and efficacy of the Pipeline device in treating intracranial aneurysms. Additionally, the study aimed to analyze the risk factors associated with long-term incomplete occlusion of the aneurysm and stenosis of the parent artery. This multicenter retrospective study included patients with intracranial aneurysms treated with the Pipeline flow-diverting device between 2015 and 2020. The analysis encompassed clinical and imaging outcomes, including clinical presentation, comorbidities, aneurysm characteristics, procedural details, and postoperative follow-up data. This study included 190 patients(122 females)with a mean age of 54.6 ± 11.7 years and 204 aneurysms. At one year postoperatively, the complete aneurysm occlusion rate was 69.9%, parent artery stenosis was 3.7%, and complications occurred in 3.3% of cases. During long-term follow-up, the occlusion rate increased to 93.1%, stenosis rose to 6.4%, and complications decreased to 2.1%. Three perforator occlusions were reported: two during the short-term follow-up and one during the long-term follow-up, resulting in severe impairment (mRS 4). The Pipeline flow-diverting device demonstrated favorable long-term safety and efficacy in the treatment of intracranial aneurysms, with no significant differences in safety or effectiveness between vertebral artery aneurysms and anterior circulation aneurysms. Statistical analysis identified advanced age and male gender as risk factors for long-term incomplete occlusion. Furthermore, the results suggest that postoperative antiplatelet therapy and imaging follow-up were continued for only one year, which is considered safe and effective.