PT  - JOURNAL ARTICLE
AU  - Kesumayadi, Irfan
AU  - Sakamoto, Makoto
AU  - Hosoya, Tomohiro
AU  - Kambe, Atsushi
AU  - Uno, Tetsuji
AU  - Yoshioka, Hiroki
AU  - Kurosaki, Masamichi
TI  - Clinical Outcome of Pipeline Embolization Device with and without Coils to Treat Intracranial Aneurysm: A Systematic Review and Meta-Analysis
AID  - 10.3174/ajnr.A8443
DP  - 2025 Feb 01
TA  - American Journal of Neuroradiology
PG  - 272--277
VI  - 46
IP  - 2
4099  - http://www.ajnr.org/content/46/2/272.short
4100  - http://www.ajnr.org/content/46/2/272.full
SO  - Am. J. Neuroradiol.2025 Feb 01; 46
AB  - BACKGROUND: The use of a Pipeline Embolization Device (PED) in combination with coils (PEDC) to treat intracranial aneurysms remains unclear as to whether it offers significant benefits for the patients because the results have varied.PURPOSE: This study aimed to investigate the clinical outcome of the PEDC compared with the PED in treating intracranial aneurysms.DATA SOURCES: We systematically searched the articles from PubMed, Web of Science, and the Cochrane Library databases published before January 25, 2024.STUDY SELECTION: We selected studies comparing the PEDC versus the PED to treat intracranial aneurysms. Patients treated with the PEDC but using dense coiling were excluded from the study.DATA ANALYSIS: The clinical outcomes observed in this meta-analysis were intraprocedural complications, postoperative complications (stenosis, stroke, hemorrhage, mortality), favorable outcome (mRS ≤2), complete occlusion rate, and retreatment rate. A forest plot was used to analyze pooled OR of clinical outcomes.DATA SYNTHESIS: A total of 3001 subjects from 9 observational studies were included. The PEDC was mainly used to treat larger aneurysms. The PEDC has a significantly higher complete occlusion rate at 6 months (OR = 2.66; 95% CI, 1.26–115.59; P = .01), a lower retreatment rate (OR = 0.18; 95% CI, 0.05–0.07; P = .010), higher stroke-related complications (OR= 1.66, 95% CI, 1.16–2.37; P = .005), and higher hemorrhage-related complications (OR = 1.98; 95% CI, 1.22–13.21; P = .005). There was no significant difference in intraprocedural complications, stenosis-related complications, mortality, favorable outcomes, and complete occlusion at the end of the study.LIMITATIONS: No randomized controlled trials have been performed comparing the PEDC and PED. Considering that all the included studies were observational, the patients’ baseline characteristics were not completely balanced.CONCLUSIONS: This meta-analysis study showed that the PEDC in large intracranial aneurysms induces a faster complete occlusion rate at 6 months and a lower retreatment rate. However, it increases the risk of stroke-related postoperative complications, and the faster complete aneurysm occlusion rate found in this study did not correlate with a reduction in long-term aneurysm or distal artery ruptures. Thus, this study suggests the need to find a better strategy to improve long-term hemorrhage-related complications in large intracranial aneurysms.FDDsflow-diverter devicesNOSNewcastle-Ottawa ScalePEDCPipeline Embolization Device in combination with coils