1178. Pipeline Embolization Device vs Stent-Assisted Coiling for Intracranial Aneurysms Treatment: A Retrospective and Propensity Score-Matched Study

Authors: Mohamed Salem; Mohamed Salem, MD; Alejandro Enriquez-Marulanda, MD; Luis Ascanio, MD; Noah Jordan, BS; Santiago Gomez-Paz, MD; Paul Foreman, MD; Christopher Ogilvy, MD; Ajith Thomas, MD; Justin Moore, MD, PhD (Boston, MA)

Introduction:

Pipeline embolization device (PED) and stent-assisted coiling (SAC) are established modalities for treatment of intracranial aneurysms. Previous studies comparing both are limited by selection bias. We sought to comparatively assess the efficacy of these techniques with regard to primary outcome of aneurysm occlusion and secondary outcomes of complications rates and functional outcomes at last follow up.

Methods:

We conducted a retrospective analysis of patients with intracranial aneurysms admitted to our institution and treated with either PED from 2013 to 2017 or SAC from 2009 to 2015. Patients were matched using nearest neighbor propensity score matching (PSM) controlling for the following variables: age, morphology, circulation, maximal diameter, multiple aneurysms, smoking. STATA 15 was used for analyses, p-values <0.05 for significance.

Results:

Out of 323 patients identified for this cohort, 241 (74.6%) were treated by PED, 82 patients (25.4%) were treated using SAC. Patients treated with PED were younger (p<0.001), and more likely to have multiple aneurysms (p=0.04). Anterior circulation aneurysms were more likely treated with PED (p<0.001), and no fusiform aneurysms were treated with SAC (p=0.002). Incompletely occluded aneurysms were significantly more common in the PED cohort (18.1% vs 6.3%; p=0.006). PSM resulted in 31 matched pairs; with no difference between the two groups for mRS on last clinical follow up or procedural complications. Mean elapsed time to last imaging follow-up was 13.8 vs 9.8 months, respectively. Complete occlusion rates were higher in the SAC group, borderlining statistical significance (93.6 vs 77.4%; p=0.07). Diversely, there was a trend for higher retreatment in the SAC group (9.7% vs 0%; p=0.07).

Conclusion:

PED placement and SAC for the treatment of intracranial aneurysms offer similar functional outcomes and procedural complication rates.  Use of the PED was associated with increased rates of incomplete aneurysm occlusion, while SAC was associated with increased retreatment risk.