From the Guidelines
Pipeline embolization devices achieve high occlusion rates for brain aneurysms at 6 months, typically ranging from 73% to 87%. Complete occlusion rates tend to increase over time, with many studies showing progressive improvement between initial treatment and the 6-month follow-up imaging 1. Factors affecting occlusion success include aneurysm size, location, morphology, and the technical aspects of device deployment. Larger aneurysms generally have lower complete occlusion rates compared to smaller ones. The Pipeline device works by diverting blood flow away from the aneurysm, promoting thrombosis within the aneurysm sac while maintaining patency of the parent vessel and branch arteries. This flow diversion technique allows for gradual aneurysm occlusion over time, which explains why occlusion rates continue to improve beyond the 6-month mark.
Some key points to consider when using Pipeline embolization devices include:
- The importance of proper device deployment and positioning to ensure optimal occlusion rates
- The need for dual antiplatelet therapy (usually aspirin and clopidogrel) for at least 3-6 months after Pipeline placement to prevent thromboembolic complications while the device endothelializes
- The potential for complications, such as thromboembolic events, aneurysm rupture, and neurological complications, which can be minimized with proper patient selection and technique
- The need for long-term follow-up imaging to monitor aneurysm occlusion and detect any potential complications. According to the guidelines for the management of patients with unruptured intracranial aneurysms, endovascular treatment, including the use of Pipeline embolization devices, is a reasonable option for patients with unruptured aneurysms who are at high risk for surgical complications or have aneurysms that are difficult to treat surgically 1.
From the Research
Cerebral Aneurysm Occlusion Rates with Pipeline Embolization Device
- The cerebral aneurysm occlusion rates at 6 months with the Pipeline Embolization Device have been reported in several studies:
- A systematic literature review of the pipeline shield device reported an adequate occlusion rate of 73.9% (95% CI: 69.1-78.7%) at 6 months 2.
- A study on the Pipeline Embolization Device with Shield Technology reported an adequate occlusion rate of 78.8% at 6 months 3.
- A prospective registry study on the use of the PED for unruptured aneurysms reported an overall occlusion rate of 85.7% at 6 months 4.
- A study on the new fourth generation Pipeline Vantage Flow Diverter reported an occlusion rate of 81.7% at 6 months 5.
- A study on the use of the PED for recurrence of previously treated aneurysms reported a complete occlusion rate of 80% at 6 months 6.
Comparison of Occlusion Rates
- The occlusion rates at 6 months vary across studies, ranging from 73.9% to 85.7%.
- The study with the highest occlusion rate at 6 months was the prospective registry study on the use of the PED for unruptured aneurysms, which reported an overall occlusion rate of 85.7% 4.
- The study with the lowest occlusion rate at 6 months was the systematic literature review of the pipeline shield device, which reported an adequate occlusion rate of 73.9% 2.
Factors Affecting Occlusion Rates
- The occlusion rates may be affected by various factors, including aneurysm size, location, and previous treatment.
- The study on the use of the PED for recurrence of previously treated aneurysms reported a complete occlusion rate of 100% at 12 months in patients who underwent PED placement following failed endovascular coiling or microsurgical clipping 6.
- The study on the new fourth generation Pipeline Vantage Flow Diverter reported an occlusion rate of 81.7% at 6 months, with no significant difference in occlusion rates between aneurysms in the anterior and posterior circulations 5.