Long-Term Follow Up Study Of Pipeline Embolization Device For The Treatment Of Complex Intracranial Anterior Circulation Aneurysms

Objective:To investigate the long-term outcomes of intracranial complex anterior circulation aneurysms with Pipeline embolization device(PED)treatment.Methods: We retrospectively reviewed the clinical data of 58 patients with intracranial complex anterior circulation aneurysms,including the 8 ruptured and 50 unruptured aneurysms,which treated with PED in the first affiliated hospital of Xinjiang medical un iversity from May 2015 to September 2018.Angiographic and clinical outcomes were evaluated in terms of the O’Kelly-Marotta(OKM)grading scale and modified Rankin scale(mRS)score at each follow-up.Results: All of the 58 patients were successfully implanted PEDs and immediate post-operative angiography revealed complete occlusion(OKM Grade D)in 8(13.8%)aneurysms.Short,mid and long-term follow ups were performed at 4-9(5.8±1.1)months,10-18(12.8±2.1)months and 24-52(33.9±8.3)months,respectively,d emonstrating the complete aneurysm occlusion(OKM Grade D)rates of 87.7%(50/57),96.6%(55/56)and 100%(47/47),which were statistically significant compared to the immediate post-operative complete occlusion rate of 13.8%(P< 0.01).Correspondingly,favorable outcome(mRS 0-2)rates were 96.6%(56/58),98.2%(55/56),and 97.9%(46/47).The overall complications included two hemorrhagic events,two died cases,four asymptomatic occlusion of the covered branches,three groin hematomas,two visual abnormalit ies and one hematemesis due to superior digestive tract bleeding.Of the 8 ruptured aneurysm,grade D occlusion were observed in 5/7 、 6/6 and 5/5 aneurysms at each follow up,respectively.There were four complications in the ruptured aneurysms group involving the two hemorrhagic events,one hydrocephalus and one case of visual abnormality,and two of them died.Conclusion: Intracranial complex anterior circulation aneurysm treatment with PED has a l ow morbidity-mortality as well as high complete occlusion rate,but it is important to think cautiously before choose PED for ruptured aneurysm due to their high complication rates.