BACKGROUND:Approximately 25% of aneurysms treated with Pipeline remain incompletely occluded at 6 months. This study aimed to develop and externally validate a novel preoperative scoring system to predict the risk of incomplete occlusion. METHODS:This retrospective multicenter study developed a model using data from 588 patients (659 aneurysms) (PLUS study, 2014-2019). An external validation cohort consisted of 189 patients with 235 aneurysms from a single participating center (2020-2022). Feature selection was performed using the least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression modeling. Model performance was assessed by the Area Under the Curve (AUC), calibration, and bootstrap validation. A points-based Pre-scope score was derived and compared with the DIANES score (DeLong test; R software v4.2.0). RESULTS:Eight predictors were identified, including aneurysm diameter, stent diameter, stent-parent diameter ratio, branch artery involvement, coil assistance, aneurysm type, and location. The model shows good discriminative power with an AUC of 0.802 and good calibration. The model also provided good discrimination (AUC of 0.795) and good calibration in the validation cohort. After conversion into a points-based system, the Pre-scope score showed good discriminative ability, with AUCs of 0.775 and 0.794 in the training and validation cohorts, respectively. Compared with the DIANES score, this score has good discriminative ability (verification cohort AUC: 0.794 vs. 0.651, P ＜0.05). CONCLUSION:The Pre-scope score, based on a large multicenter dataset with independent temporal validation, is a practical preoperative tool with superior predictive ability. It may support individualized surgical strategies and improve patient outcomes.

Stent-assisted coiling (SAC) and flow diverters (FDs) are common endovascular treatments for intracranial bifurcation aneurysms. However, studies comparing FDs and SAC were scarce. Thus, we performed a two-center, propensity score matched (PSM) cohort study to compare the FDs and SAC devices for intracranial bifurcation aneurysms. Consecutive patients with intracranial bifurcation aneurysms were treated with FDs or SAC at two advanced stroke centers were enrolled in the study. Propensity score matching (PSM) was employed to adjust for demographic and aneurysm characteristics. The perioperative and midterm follow-up outcomes were compared between the two devices. A total of 131 patients with 131 intracranial bifurcation aneurysms were included. After PSM, 66 aneurysms treated with the FDs and SAC were matched (n = 33 in each group). At a median follow-up of 6–7 months, significant differences were observed in procedure time (105.00 min vs. 155.00 min, p < 0.001), rate of complete aneurysm occlusion (60.6

For participants with intracranial aneurysm who underwent stent treatment, light transmission aggregation–guided antiplatelet therapy helped reduce ischemic events without increasing bleeding risks.

Forsythiaside A (FA) has anti-inflammatory and antioxidant properties. The aim of this study was to explore the antioxidant effects and mechanisms of FA in ischemic stroke (IS). In this work, IS-related genes were obtained through GEO, GeneCards, TTD, CTD, DrugBank, and MalaCards databases. The targets of the FA were obtained from CTD, TargetNet, Super-PRED, TCMIO, and SwissTargetPrediction databases. GO analysis and KEGG pathway enrichment analysis were performed, and a protein-protein interaction (PPI) network was constructed to screen for key pathways. For in vivo assays, a middle cerebral artery occlusion and reperfusion (MCAO/R) model was established in rats, and high and low doses of FA were administered. Neurological impairment score, cerebral infarction, cerebral edema, and tissue morphology were evaluated. The content of reactive oxygen species (ROS), malondialdehyde (MDA) and superoxide dismutase (SOD) were detected. The expressions of cleaved caspase 3, Bax, and bcl-2, and Nrf2/HO-1 pathway-related proteins were detected by Western blot. For in vitro experiments, an oxygen-glucose deprivation/reperfusion (OGD/R) model was constructed in HT22 cells, and CCK-8 and LDH release assays were used to evaluate the effect of FA on OGD/R-induced toxicity of HT22 neurons. The Nrf2 inhibitor ML385 was used for the rescue experiments. Network pharmacology and bioinformatics analysis showed that the role of FA in treating IS was associated with oxidative stress. Topological analysis of the PPI network revealed 11 key genes, which were closely associated with the Nrf2 pathway. FA treatment could significantly reduce cerebral infarction, cerebral edema, neurological function impairment, and neuronal injury of the rats with MCAO/R. FA could also inhibit oxidative stress and neuronal apoptosis, and increase the viability of HT22 cells. In addition, FA promoted the nuclear translocation of Nrf2 and activated the Nrf2/HO-1 pathway, while ML385 weakened the protective effect of FA on neuronal viability and antioxidant capacity. In conclusion, FA attenuates the oxidative damage induced by IS by activating the Nrf2/HO-1 signaling pathway, which is a promising natural drug for IS.

Objective To evaluate the safety, efficacy, and long-term effects of catheter ablation with vein of Marshall ethanol infusion for bidirectional mitral isthmus block in patients with persistent atrial fibrillation. Methods Two hundred and forty patients from five centers with persistent atrial fibrillation (AF) who underwent radiofrequency ablation from October 2018 to December 2023 were retrospectively analyzed, including 120 patients who underwent traditional pulmonary vein isolation (PVI Only group) and 120 patients who underwent PVI and Marshall vein ablation (Marshall Plus group). The operation time, X-ray exposure, incidence of AF/atrial tachycardia (AT) and complications were compared between the two groups. Results Among the 240 patients (mean age: 57.2 ± 7.2 years, males: 195/240, 81.25 %), vein of Marshall ethanol infusion was successfully performed in 113 of 120 patients. At 12 and 36 months, the proportion of patients free from AF/ AT after a single procedure was 76.3 % (90/118) in the PVI plus vein of Marshall ethanol infusion group and 67.5 % (79/117) in the PVI only group (P < 0.01). Perimitral block was successfully achieved in 90.8 % (109/120) patients in the Marshall Plus group. Freedom from AF/AT at the 3-year follow-up (68.6 % vs. 59.8 %, P < 0.01) and incidence of adverse events were similar between the two groups. Conclusion PVI combined with Marshall venous infusion ablation can safely and effectively increase the long-term success rate of AF ablation. Duration of AF, left atrial volume(>42 mm,)and bidirectional mitral isthmus block were associated with recurrence of AF/AT.

Flow diverters (FDs) have emerged as a promising therapeutic option for unruptured intracranial aneurysms (UIAs), demonstrating favorable clinical outcomes. Nevertheless, the association between hemodynamic alterations and in-stent stenosis (ISS) following FD implantation remains poorly understood. This study sought to elucidate the independent relationship between perioperative blood flow velocity changes and ISS development in patients undergoing FD treatment for UIAs. A retrospective cohort analysis was conducted on 127 consecutive patients treated with FDs at our institution between July 2023 to September 2024. Hemodynamic parameters, including peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean velocity (MV), were meticulously assessed using transcranial color-coded duplex (TCCD) sonography at both preoperative and postoperative time points. Of the 74 patients who completed follow-up, 8 (10.81

BACKGROUND:In-stent stenosis (ISS) remains a significant adverse event following flow diverter (FD) placement for intracranial aneurysms. This study investigated whether admission fibrinogen (FIB) levels could predict ISS occurrence. METHODS:We conducted a multicenter retrospective cohort study of 394 consecutive patients who underwent FD treatment for intracranial aneurysms across 4 comprehensive stroke centers between March 2016 and October 2024. The primary predictor was admission FIB level, and the primary endpoint was angiographically confirmed ISS during 12.63 ± 9.29 months of follow-up. Multiple variables were collected, including patient demographics, aneurysm characteristics, procedural details, and vascular risk factors. The association between FIB levels and ISS was analyzed using Cox logistic regression and threshold effect analysis with 2-piecewise linear regression models. RESULTS:Among the cohort, 90 patients (22.84%) were diagnosed with ISS, all of whom exhibited asymptomatic stenosis with a stenosis rate of ≥ 25%. Threshold effect analysis identified a nonlinear relationship between FIB levels and ISS risk, with an inflection point at 2.71 g/L. Below this threshold, each unit increase in FIB was associated with a significantly lower risk of ISS (adjusted hazard ratio: 0.27; 95% confidence interval: 0.10-0.69; P = 0.006). CONCLUSIONS:Low admission FIB (< 2.71 g/L) independently predicts ISS risk after FD treatment. With each additional unit of FIB level, there was a 73% reduction in the risk of ISS after FD treatment at follow-up. These results may help identify patients at higher risk for ISS who might benefit from more intensive.

Background:Endovascular therapy is increasingly being employed in the management of distal anterior circulation aneurysms (DACAs). However, studies directly comparing the efficacy and safety of pipeline embolization devices (PEDs) and Atlas stent-assisted coiling (SAC) in the treatment of DACAs remain limited. This study aimed to compare the two endovascular treatment strategies in terms of the clinical outcomes, angiographic results, and hospital costs. Methods:Consecutive DACA patients treated at two neurosurgical centers with either the PED or Atlas SAC were studied. The angiographic and clinical outcomes, procedure details, and hospital costs of the two devices were compared. A multivariate logistic regression analysis was performed to identify the predictors of incomplete aneurysm occlusion. Results:A total of 112 consecutive patients with 114 DACAs were enrolled in the study, of whom 51 were treated with PED and 63 with Atlas SAC. The PED group had a significantly higher stent adjustment rate than the Atlas group (7.8% vs. 0%, P=0.037). The Atlas group had a longer procedure time than the PED group (147.6±45.5 vs. 132.2±32.3 minutes, P=0.047), but incurred lower hospital costs ($27,950.8±6,795.5 vs. $37,436.5±6,208.6, P<0.001). Both devices achieved comparable rates of aneurysm occlusion (P=0.692), total complications (P=0.339), and favorable neurological outcomes (P>0.99). The multivariate analysis identified the presence of an incorporated branch as an independent predictor of incomplete aneurysm occlusion [odds ratio (OR) =9.58, 95% confidence interval (CI): 2.44-37.59, P=0.001]. Conclusions:The PED and Atlas SAC are equally safe and effective in the treatment of DACAs. The PED has the advantage of a shorter operation time, while Atlas SAC is more cost-effective. The presence of an incorporated branch is an independent predictor of delayed aneurysm occlusion.

BackgroundAlthough calcium channel blockers (CCBs) are useful in stroke prevention, their specific role in preventing stroke in hypertensive patients with intracranial aneurysms undergoing endovascular stent placement remains unclear.MethodsWe retrospectively examined 458 hypertensive patients with intracranial aneurysms who underwent stent treatment, drawn from a larger multicenter cohort comprising 1326 patients across eight centers. Patients were dichotomized into two groups according to use of a CCB. Propensity score matching (PSM) was performed to balance group differences in patient and aneurysm characteristics. We conducted a comparison of patient and aneurysm characteristics, ischemic complications, and clinical outcomes between the two groups.ResultsThe CCB and non-CCB groups comprised 279 and 179 patients, respectively. PSM resulted in 165 matched pairs. After PSM, the incidence of ischemic events within 1 month of the procedure (4.2% vs 10.9%; P=0.022) and proportion of patients with modified Rankin Scale score >2 at last follow-up (1.5% vs 7.8%; P=0.013) were significantly lower in the CCB group. Among patients treated with combination therapy, inclusion of a CCB was associated with a lower incidence of ischemic events (1.5% vs 13.3%; P=0.345), but the difference was not statistically significant after correction.ConclusionsCCB use in hypertensive patients undergoing endovascular stenting for treatment of intracranial aneurysms is associated with a lower incidence of ischemic events and a lower incidence of unfavorable neurological outcomes, especially when used in combination therapy.

Background Both low-profile visualized intraluminal support (LVIS)stents and Pipeline flow diverters (FDs) are therapeutic strategies for basilar artery (BA) aneurysms, but they have not been directly compared.Methods A total of 132 consecutive patients with 139 BA aneurysms treated with either LVIS stent or Pipeline FDs were analyzed. Propensity score matching (PSM) was used to control for age, sex, hypertension, aneurysm size, shape, location, and duration of follow-up. The treatment results of these two braided stents were compared.Results LVIS stent was placed in 88 (63.3%) and Pipeline FDs in 51 (36.7%) procedures. Patients with Pipeline FDs tended to be younger and have less hypertension, whereas aneurysms had larger aneurysm size. After PSM, similar complete or near-complete occlusion rates (76.7% vs 73.3%, p = .766) and favorable functional outcomes (86.7% vs 90.0%, p = 1) were achieved in patients treated with LVIS stents and Pipeline FDs, respectively. Further comparisons were conducted at three different locations (basilar apex/basilar trunk/vertebrobasilar artery junction [VBJ]) separately, and the results showed a higher complete or near-complete aneurysm occlusion rate after Pipeline FD treatment than LVIS treatment (86.7% vs 59.2%, p = .012) only at VBJ, where a particularly high proportion of non-saccular shape (70.9%) and a male preponderance were noted.Conclusion Both braided stents were effective in the treatment of BA aneurysms, with good occlusion rates and favorable functional outcomes. Pipeline FD achieved a particularly higher aneurysm occlusion rate than LVIS stent at VBJ, where lesions often require reconstruction of the diseased vessel.

Background Intracranial fusiform aneurysms are less common than saccular aneurysms, but are associated with higher mortality and morbidity. We conducted this study to determine the safety and efficacy of the pipeline embolization device (PED) to treat intracranial fusiform aneurysms. Methods This was a multicenter, retrospective, and observational study. Data for this study came from the PLUS study conducted from 2014 to 2019 across 14 centers in China. Univariate and multivariable logistic regression analyses were performed to evaluate predictors of the occlusion rate and complication. Results A total of 1171 consecutive patients with 1322 intracranial aneurysms participated in this study. Among the participants, 104 patients with 109 fusiform aneurysms were eligible for this analysis (mean age 49 years, 36.5% women, aneurysm mean size 14.7 mm, 55% in the posterior circulation, and 6% in the basilar artery). Mean follow-up time was 9.0 months (range 3–36 months). The last DSA angiographic follow-up was available for 85 patients, and 58 aneurysms (68.2%) were completely occluded. The overall complication rate and mortality were 17.3% and 2.8%, respectively. Multivariate analysis demonstrated that age (OR=1.007, p=0.037) and cerebral atherosclerosis (OR=1.441, p=0.002) were associated with incomplete occlusion of fusiform aneurysms after PED treatment. Conclusion PEDs may be an effective treatment for intracranial fusiform aneurysms, with a favorable occlusion rate. However, because these treatments have a relatively high rate of complications, PED treatment for fusiform aneurysms should be carefully and strictly controlled. Our analysis showed that PEDs with adjunctive coiling did not significantly improve the occlusion rate of fusiform aneurysms.

To analyze the effect of tirofiban on ischemic events in CYP2C19 loss-of-function (LOF) allele carriers during pipeline embolization device (PED) implantation. Demographic information, imaging data, ischemic complications, CYP2C19 genotyping, and platelet function test results were collected from patients with PED-treated intracranial aneurysms at three centers. Multivariate logistic regression was used to analyze risk factors for ischemic events. Patients were grouped according to LOF alleles and antiplatelet drugs, the baseline information of LOF allele carriers and non-carriers were compared, and the efficacy of tirofiban was analyzed by comparing the incidence of ischemic events in each group. In total, 278 patients were included in the study, 24 of whom had an ischemic event. 157 (56.5%) patients carried the LOF allele and were more likely to develop resistance to clopidogrel ( P < 0.001) and hypertension ( P = 0.010). Multivariate logistic regression analysis revealed that the independent risk factors for ischemic events were age of > 55 years (OR = 3.308, P = 0.028), LOF alleles (OR = 3.960, P = 0.036), and clopidogrel nonresponsiveness (OR = 3.301, P = 0.014). For LOF allele carriers, prophylactic use of tirofiban after PED implantation helped to reduce ischemic events (4.3% vs. 16.4%, P = 0.039). This study supports CYP2C19 genotyping before flow diversion because LOF alleles increase the risk of ischemic events. Prophylactic use of tirofiban may help reduce ischemic events in LOF allele carriers.

ABSTRACT Background The goal of standard dual antiplatelet therapy (SDAT) in patients undergoing endovascular interventional treatment of intracranial aneurysms is to prevent thrombosis; however, some patients have a poor response to these drugs, which increases the risk of cerebral infarction. This study aims to examine whether adjusting antiplatelet therapy based on light transmission aggregometry (LTA) can reduce the incidence of ischemic events compared with SDAT. Methods We will conduct a cluster randomized controlled trial using 16 treatment teams from eight hospitals in mainland China, enrolling 590 patients with unruptured intracranial aneurysms treated using endovascular stent placement. The treatment teams serving as clusters will be randomly assigned to either the test or control group at a 1:1 ratio. Test group patients will receive an antiplatelet regimen guided by LTA. Control group patients will receive SDAT. Patients will be followed for 1 month after the treatment period. The primary outcome measure is cerebral ischemic events within 30 days of stent placement, including stent thrombosis, ischemic stroke, and transient ischemic attack. The safety measure is all bleeding events within 30 days of treatment. Discussion The trial aims to determine whether LTA-guided antiplatelet therapy reduces the incidence of ischemic events without increasing the risk of bleeding in patients with intracranial aneurysms treated with endovascular stenting. Completion of this clinical trial may provide an individualized safe and effective regimen for antiplatelet therapy. Trial registration ClinicalTrials.gov, NCT05825391 . Registered on April 11, 2023. What is already known on this topic Dual antiplatelet therapy is administered to reduce thrombotic events in neurointerventional therapy of intracranial aneurysms. Platelet function testing is used to evaluate the antiplatelet effect of aspirin and clopidogrel. What this study adds The trial aims to determine whether LTA-guided antiplatelet therapy reduces the incidence of ischemic events without increasing the risk of bleeding in patients with intracranial aneurysms treated with endovascular stenting. How this study might affect research, practice or policy For stent neurointerventional therapy of unruptured intracranial aneurysms, this study could provide a promising method for adjusting appropriate antiplatelet therapy.

[This corrects the article DOI: 10.3389/fsurg.2022.1054416.].

BACKGROUND:Pipeline embolization devices (PEDs) have been increasingly used for the treatment of posterior circulation aneurysms.OBJECTIVE:To investigate the safety and efficacy of PED in the treatment of small to medium unruptured vertebral artery intracranial aneurysms (VAIAs).METHODS:Data from 76 patients with 78 unruptured small and medium (≤12 mm) VAIAs were analyzed. Data for this study come from the PLUS study, which was conducted at 14 centers in China from 2014 to 2019. Univariate analyses were performed to evaluate predictors of the occlusion and complication.RESULTS:Seventy-eight aneurysms in 76 patients were treated with PED. The mean aneurysm size was 8.28 ± 2.13 mm, and all PEDs were successfully placed. The median follow-up was 7 months and available for 67 (85.9%) aneurysms. Complete occlusion was seen in 60 (89.6%) aneurysms, which 86.6% met the primary efficacy outcome. All patients received clinical follow-up, the combined major morbidity and mortality was 2.6%, and 98.7% of patients had a good prognosis. Ischemic stroke occurred in 10.5% of patients, and adjuvant coil and successful after adjustment were predictors of ischemic stroke in the early postoperative and follow-up, respectively. There was no significant difference in the occlusion rate of aneurysm involving posterior inferior cerebellar artery ( P = .78). In cases where posterior inferior cerebellar artery was covered by PED, there was no significant difference in ischemic stroke.CONCLUSION:In the treatment of unruptured ≤12 mm VAIAs, PED has a high surgical success rate, a high degree of occlusion, and low morbidity and mortality. PED may be a promising endovascular technique.

Objective: Peri-ophthalmic aneurysm is a special type of aneurysm. We assessed the relationship between ophthalmic artery (OA) origin and aneurysm and examined the effect of a pipeline embolization device (PED, Covidien/Medtronic) with or without coils on aneurysm occlusion rate and visual outcomes. Methods: We retrospectively analyzed 194 peri-ophthalmic aneurysms in 189 patients among 1,171 patients treated with a PED in a Chinese post-market multi-center registry study from November 2014 to October 2019. Peri-ophthalmic aneurysms were defined as carotid–ophthalmic segment aneurysms arising from the internal carotid artery dorsal wall at, or distal to, the OA origin, with a superior or superomedial projection. The relationship between OA origin and the aneurysm was classified as follows: Type A, OA originating separate from the aneurysm; Type B, OA originating from the aneurysm neck or dome. Patients with aneurysm were divided into the PED-only group and the PED + coils group according to treatment. Results: The median follow-up time was 6.8 months (range, 5.3–20.2 months). There were 163 occluded aneurysms (84%) and 31 aneurysms with incomplete occlusion (16%). A multivariate analysis showed that Type B aneurysm was a risk factor for incomplete occlusion in the PED-only group (odds ratio [OR] 4.951, 95% confidence interval [CI] 1.904-12.875, p = 0.001). Visual symptoms at final follow up correlated with preoperative visual symptoms (OR 16.005, 95% CI 2.505-102.273, p = 0.003). Conclusions: Type B aneurysm is associated with a lower occlusion rate after PED-only treatment. Patients with preoperative visual symptoms should be treated promptly to avoid permanent visual symptoms.

ObjectiveThe purpose of this work was to summarize the real-world safety and efficacy of Pipeline Embolization Device (PED) therapy for small and medium-sized intracranial aneurysms in China.MethodsPatients from the PED in China post-market multi-center registry study (PLUS) with aneurysms smaller than 12 mm were selected. Radiographic outcomes were assessed using digital subtraction angiography. Clinical outcomes included functional outcomes (modified Rankin Scale, MRS) in the early postoperative period ( ≤ 30 days) and early postoperative complications associated with PED therapy.ResultsA total of 652 patients with a combined 754 aneurysms were included in this study (mean age of 53.9 ± 10.3 years, 68.7% women). Mean aneurysm diameter was 6.78 ± 2.67 mm. Of the 687 stents deployed, 99.7% (685/689) were successfully deployed. In this study, 64.7% (488/754) of aneurysms were treated with only the PED, whereas 35.3% (266/754) were subjected to PED-assisted therapy. Radiographic outcome at the last follow-up (median time: seven months) was available for 64.3% (485/754) of the aneurysms. 82.5% (400/485) of aneurysms demonstrated complete occlusion (Raymond Roy Grade I). 81.4% (395/485) of aneurysms were found to meet the study's primary effectiveness outcome. At the early postoperative period, the mRS score was determined to be 0–2 vs. 3-6 in 98.2% (640/652) vs. 1.8% (12/652) of the cases, respectively. The combined major morbidity and mortality rate was 3.2% (21/652).ConclusionIn the largest study of PED therapy for small and medium-sized intracranial aneurysms to date, pipeline-assisted coil embolization was chosen more often than multiple stent implantation for aneurysm treatment, demonstrating good results, high surgical success rates, high occlusion rates, and low morbidity and mortality.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03831672.

Department of Ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China Department of Neurosurgery, Beijing Neurosurgical Institute, Beijng 100040, China Department of Neuro-intervention, Beijing Tiantan Hospital, Capital Medical University, Beijing 100040, China Correspondence to: Li-Ke Xie. Department of Ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100040, China. drlikexie@163.com Received: 2022-05-17 Accepted: 2022-08-08

BACKGROUND:In-stent stenosis (ISS) is a delayed complication that can occur after pipeline embolization device use when treating intracranial aneurysms (IAs).OBJECTIVE:To assess the incidence, predictors, and outcomes of ISS.METHODS:This was a retrospective, multicenter, observational study. All patient data were collected from a PLUS registry study. We collected data from patients with IA who completed digital subtraction angiography at follow-up and divided patients into "non-ISS," "mild ISS," or "severe ISS" groups. Multivariate logistic regression analysis was conducted to determine predictors of ISS.RESULTS:A total of 1171 consecutive patients with 1322 IAs participated in this study. Angiographic follow-up was available for 662 patients with 728 IAs, and the mean follow-up time was 9 months. ISS was detected in 73 cases (10.03%), including 61 mild ISS cases and 12 severe ISS cases. Univariate and multivariable analysis demonstrated that current smoking history (mild ISS: OR 2.15, 95% CI 1.122-4.118, P = .021; severe ISS: OR 5.858, 95% CI 1.186-28.93, P = .030) and cerebral atherosclerosis (mild ISS: OR 5.694, 95% CI 3.193-10.15, P = .001; severe ISS: OR 6.103, 95% CI 1.384-26.91, P = .017) were independent predictors of ISS. Compared with the other groups, the severe ISS group had higher rate of ischemic stroke (33.3%).CONCLUSION:ISS occurs in approximately 10.03% of cases at a mean follow-up of 9 months. Statistically, current smoking history and cerebral atherosclerosis are the main predictors of ISS. Severe ISS may be associated with higher risk of neurological ischemic events in patients with IA after pipeline embolization device implantation.

Objective:Intracranial fusiform aneurysms are uncommon and can occur in vessels of the anterior circulation (AC) or posterior circulation (PC). While flow diversion is one treatment option, research into Pipeline Embolization Device (PED) treatment is lacking. This study explored the efficacy and safety of PED treatment for intracranial fusiform aneurysms, and compared therapeutic effects between AC and PC aneurysms. MethodsIn the post-market multi-center cohort study of embolization of intracranial aneurysms with PED in China (PLUS) registry study, we retrospectively analyzed 71 fusiform aneurysms in 67 patients among 1,171 patients treated with a PED from November 2014 to October 2019. The general characteristics, perioperative status, aneurysm occlusion rate at the last follow-up angiography, and changes in modified Rankin Scale scores were analyzed. Aneurysms were divided into AC and PC groups, and univariate and multivariate analyses were conducted. ResultsThe study included 26 AC (25 patients) and 45 PC (42 patients) aneurysms. A total of 75 PEDs were used, an average of 1.1 PEDs were used, and the median follow-up was 6.7 months. Fifty aneurysms (71.4%) were occluded and twenty (28.5%) were incompletely occluded. There were significantly more occluded aneurysms in the PC group than in the AC group (12 vs. 38; P = 0.001). Risk factors for incomplete occlusion were AC aneurysms (P = 0.001) and a perforating artery originating from the aneurysm (P = 0.006). The mean modified Rankin Scale score was significantly lower at the last follow up than preoperatively (0.58 vs. 0.21; P = 0.0001). ConclusionNon-overlapping PED is a safe and effective treatment for both AC and PC fusiform aneurysms. The occlusion rate of AC fusiform aneurysms is lower than that of PC.