Treatment of Tandem Internal Carotid Artery Aneurysms Using a Single Pipeline Embolization Device: Evaluation of Safety and Efficacy

Article Figures & Data

Table 1:

Baseline characteristics

Parameter	Solitary Aneurysm	Tandem Aneurysms	P Value
No. of PEDs placed	184	34	–
Aneurysms treated with single PED	184	78	–
1	184	–	–
2	–	28	–
3	–	3	–
4	–	2	–
5	–	1	–
Sex
Female	166 (90.2%)	31 (91.2%)	.86
Male	18 (9.8%)	3 (8.8%)	.86
Median age (median) (range) (yr)	58 (24–82)	50.5 (19–75)	.006
Smoking (No.)	42 (22.8%)	18 (52.9%)	<.001
Pretreatment mRS (No.)
0–2	180 (97.8%)	32 (94.1%)	.23
3–5	4 (2.2%)	2 (5.9%)	.23
Aneurysm location
Cavernous	25 (13.6%)	7 (9%)	.53
Paraophthalmic	133 (72.3%)	61 (78.2%)
Posterior communicating	26 (14.1%)	10 (12.8%)
Aneurysm measurements (median) (range) (mm)
Maximal diameter	6.2 (1.6–28.3)^{^a}	6.7 (2–40)	.48
Neck size	4 (1–14.3)^{^b}	3.9 (1.8–8.5)^{^c}	.14
Daughter sac (No.)	46 (25.1%)	12 (15.4%)	.08
Subarachnoid hemorrhage (No.)
Acute (<2 weeks)	4 (2.2%)	3 (8.8%)	.11
Remote (>2 weeks)	19 (10.3%)	2 (5.9%)	.11
Prior treatment (No.)
Endovascular	23 (12.5%)	2 (2.6%)	.031
Surgery	6 (3.3%)	0
Both	2 (1.1%)	1 (1.3%)
Clopidogrel responders (No.)
Yes	123 (68.7%)^{^d}	24 (75%)^{^e}	.48
No	56 (31.3%)	8 (25%)	.48

Table 3:

Occlusion rate

Occlusion Rate	Solitary Aneurysm	Tandem Aneurysms		P Value
Occlusion Rate	Solitary Aneurysm	Largest Aneurysm	Other Aneurysms	P Value
Complete (100%)	109 (75.1%)^{^a}	36 (90%)^{^b}	26 (86.6%)^{^b}	.21
Near-complete (90%–99%)	12 (8.3%)	2 (5%)	2 (6.7%)
Partial (<90%)	24 (16.6%)	2 (5%)	2 (6.7%)

Table 4:

Outcome measures

Parameter	Solitary Aneurysm	Tandem Aneurysms	P Value
Length of procedure (median) (range) (min)	69.5 (16–192)^{^a}	76 (19–194)^{^b}	.52
PED dimensions (median) (range) (mm)
PED length	19 (12–35)	20 (6–30)	.42
PED diameter	4 (2.5–5.5)	4 (3.5–5)	.26
Last angiographic follow-up (median) (range) (mo)	12 (1–79)^{^c}	18 (4.8–51)^{^d}	.008
Follow-up occlusion rate (No.)
Complete (100%)	109 (75.1%)^{^c}	62 (88.6%)^{^d}	.06
Near-complete (90%–99%)	12 (8.3%)	4 (5.7%)
Partial (<90%)	24 (16.6%)	4 (5.7%)
Retreatment (No.)
Endovascular	7 (4.9%)	4 (5.7%)	.81
Posttreatment mRS (No.)
0–2	169 (98.8%)^{^e}	32 (97%)^{^f}	.42
3–5	2 (1.2%)	1 (3%)	.42
Follow-up mRS (No.)
Improved	47 (27.5%)^{^e}	9 (27.3%)^{^f}	.33
No change	112 (65.5)	24 (72.7%)
Worsened	12 (7%)	0
Neurologic complications (No.)
Symptomatic thromboembolic	5 (2.7%)	3 (8.8%)	.08
Permanent	3 (1.6%)	1 (2.9%)	.60
Symptomatic hemorrhagic	2 (1.1%)	1 (2.9%)	.39