Time Line of Occlusion for Intracranial Aneurysms Treated with the Pipeline Embolization Device

-BACKGROUND: Rates of aneurysm occlusion following treatment with flow-diverting stents have been quantified at predefined time points in clinical trials, but data char-acterizing the continuous temporal progression of aneu-rysm occlusion are lacking. This study used real-world variability in timing of angiographic follow-up to charac-terize the time line of aneurysm occlusion following treatment with the Pipeline embolization device (PED).-METHODS: All aneurysms treated with a PED at our institution between 2011 and 2020 were screened. Non-saccular or ruptured aneurysms were excluded. Aneurysm occlusion status and time since treatment were recorded for each follow-up angiogram. Aneurysm occlusion was characterized using Kaplan-Meier and Cox proportional hazards analysis after censoring at last follow-up or sub-sequent treatment.-RESULTS: There were 290 aneurysms in 222 patients analyzed. The median time of observed aneurysm occlusion was 7.5 months, and overall rate of aneurysm occlusion was 77.9%. Larger aneurysms demonstrated a longer me-dian time to occlusion and lower rate of aneurysm occlu-sion (P = 0.029). There were no observed differences in the time line of occlusion for aneurysms treated with a single PED or multiple PEDs (P = 0.889) or without or with adjunctive coiling (P = 0.771).-CONCLUSIONS: Aneurysms treated with a PED had a median time to observed occlusion of 7.5 months. Occlu-sion of larger aneurysms occurred more slowly than oc-clusion of smaller aneurysms following flow diversion. The n umber of PEDs deployed or the use of adjunctive coiling did not affect the time line or likelihood of aneurysm oc-clusion. These findings may guide optimal timing of follow-u p after treatment with a PED.

Automated summary

This study characterized the timeline of aneurysm occlusion following treatment with the Pipeline embolization device (PED) using real-world variability in timing of angiographic follow-up. Larger aneurysms demonstrated a longer median time to occlusion and lower rate of aneurysm occlusion, while the number of PEDs deployed or the use of adjunctive coiling did not affect the time line or likelihood of aneurysm occlusion.