1021. An Eight Year Journey Of Flow Diverter, Outcomes Achieved and Lessons Learned

Authors: Ahmad Sweid; Stavropoula Tjoumakaris, MD; Somnath Das, BS; Michael Baldassari,, BA; Sage Rahm, BA; Varun Singh, BS; Michael Gooch, MD; Nabeel Herial, MD; Robert Rosenwasser, MD; Pascal Jabbour, MD (Philadelphia, PA)

Introduction: Pipeline embolization device has emerged as a pivotal advancement in endovascular aneurysm treatment. Its efficacy and safety has been well established in complex aneurysms. The use expanded from their first FDA approved indication. Moreover, complication rates have been shown to decline as new skill sets are acquired and with new generation devices. The authors evaluated predictors of occlusion and long-term occlusion rate, predictors of complication and complication rate using the largest, single-center series reflecting a real-world experience Methods: Chart analysis of 598 patients treated with PED over the eight-year period Results: Total of 598 aneurysms were treated using PED (85% were female, median size=9mm, saccular=84%, and 19% previously treated). The morbidity and mortality rate was 5% with a higher rate for posterior circulation,9%. The good functional outcome was observed in 92%. Follow-up angiogram studies were available for 90% of PED. Complete occlusion was achieved in 75%, 80%, and 86% at 6, 12, and 24 months, respectively. The residual filling was seen in 14 % were a second PED was added. Smaller proximal aneurysms were more likely to occlude earlier than large aneurysm. No recanalization of a previously completely occludedaneurysmwas noted. Aneurysmsize, prior stent placement, branch vessel inclusion were predictors of aneurysm persistence. 2.5% had intraparenchymal hemorrhage which was ipsilateral in 80%, symptomatic thromboembolic complications were encountered in 2.7%, and in-stent thrombosis was seen in 0.5%. On multivariate logistic regression analysis, increasing age, ruptured aneurysm, use of >3PED was associated with higher likelihoods of combined morbidity and mortality Conclusion: This is the largest single-institution study showing high rates ofaneurysm occlusion after Pipeline embolization and low rate of morbidity and mortality.Predictors of complication were increasing age, ruptured aneurysm and the use of >3PED while aneurysm size, prior stent placement, and branch vessel occlusion predicted aneurysm persistence