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The Pipeline Embolization Device: learning curve and predictors of complications and aneurysm obliteration.

Publication ,  Journal Article
Jabbour, P; Chalouhi, N; Tjoumakaris, S; Gonzalez, LF; Dumont, AS; Randazzo, C; Starke, RM; Hasan, D; Chitale, R; Singhal, S; Moukarzel, LA ...
Published in: Neurosurgery
July 2013

BACKGROUND: The Pipeline Embolization Device (PED) has emerged as a promising treatment for intracranial aneurysms. OBJECTIVE: To assess the safety and efficacy of the PED, to analyze the effect of operator experience on the complication rate, and to identify predictors of complications and obliteration. METHODS: A total of 109 patients with 120 aneurysms were treated with PED at our institution. The patient population was divided into 3 consecutive equal groups to assess whether overall and major complication rates decreased over time: group 1, patients 1 through 37; group 2, patients 38 through 73; and group 3, patients 74 through 109. RESULTS: The number of PEDs used was 1.40 per aneurysm. Symptomatic and major procedure-related complications occurred in 11% and 3.7% of patients, respectively. The rate of complications decreased from 16.2% in group 1 to 5.6% in group 3, and the rate of major complications fell dramatically from 10.8% in group 1 to 0% in groups 2 and 3 (P < .05). Procedure time significantly decreased over time (P = .04). In multivariate analysis, previously treated aneurysms were predictive of procedural complications (P = .02). At the latest follow-up, 65.8% of aneurysms were completely occluded, 9.6% were nearly completely occluded, and 24.6% were incompletely occluded. In multivariate analysis, fusiform aneurysms (P = .05) and shorter angiographic follow-up (P = .03) were negative predictors of aneurysm obliteration. CONCLUSION: PED therapy may have an acceptable safety-efficacy profile. The risk of complications appears to decrease dramatically with physician experience, supporting the existence of a learning curve. Patients with previously treated aneurysms have higher complication rates, whereas fusiform aneurysms achieve lower obliteration rates.

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Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

July 2013

Volume

73

Issue

1

Start / End Page

113 / 120

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Risk Factors
  • Retrospective Studies
  • Recovery of Function
  • Prevalence
  • Postoperative Complications
  • Pennsylvania
  • Neurology & Neurosurgery
  • Middle Aged
 

Citation

APA
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ICMJE
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Jabbour, P., Chalouhi, N., Tjoumakaris, S., Gonzalez, L. F., Dumont, A. S., Randazzo, C., … Rosenwasser, R. (2013). The Pipeline Embolization Device: learning curve and predictors of complications and aneurysm obliteration. Neurosurgery, 73(1), 113–120. https://doi.org/10.1227/01.neu.0000429844.06955.39
Jabbour, Pascal, Nohra Chalouhi, Stavropoula Tjoumakaris, L Fernando Gonzalez, Aaron S. Dumont, Ciro Randazzo, Robert M. Starke, et al. “The Pipeline Embolization Device: learning curve and predictors of complications and aneurysm obliteration.Neurosurgery 73, no. 1 (July 2013): 113–20. https://doi.org/10.1227/01.neu.0000429844.06955.39.
Jabbour P, Chalouhi N, Tjoumakaris S, Gonzalez LF, Dumont AS, Randazzo C, et al. The Pipeline Embolization Device: learning curve and predictors of complications and aneurysm obliteration. Neurosurgery. 2013 Jul;73(1):113–20.
Jabbour, Pascal, et al. “The Pipeline Embolization Device: learning curve and predictors of complications and aneurysm obliteration.Neurosurgery, vol. 73, no. 1, July 2013, pp. 113–20. Pubmed, doi:10.1227/01.neu.0000429844.06955.39.
Jabbour P, Chalouhi N, Tjoumakaris S, Gonzalez LF, Dumont AS, Randazzo C, Starke RM, Hasan D, Chitale R, Singhal S, Moukarzel LA, Rosenwasser R. The Pipeline Embolization Device: learning curve and predictors of complications and aneurysm obliteration. Neurosurgery. 2013 Jul;73(1):113–120.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

July 2013

Volume

73

Issue

1

Start / End Page

113 / 120

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Risk Factors
  • Retrospective Studies
  • Recovery of Function
  • Prevalence
  • Postoperative Complications
  • Pennsylvania
  • Neurology & Neurosurgery
  • Middle Aged