Clinical Effect Analysis Of Pipeline Embolization Device For Intracranial Vertebrobasilar Trunk Large Aneurysms

Objective:To investigate the safety and effectiveness of the Pipeline Embolization Device in the treatment of large intracranial vertebrobasilar trunk aneurysms,focusing on analyzing the related factors of perioperative complications and the related factors affecting the long-term efficacy of aneurysms.Methods:A retrospective analysis was performed on the clinical data of 90 patients with unruptured vertebrobasilar trunk aneurysms(diameter greater than 10mm)admitted to 14 neurosurgery centers participating in PLUS study from November 2014 to October 2019.All of these patients received PED treatment.Clinical outcome and disability function were assessed using the modified Rankin Scale score(m RS).Raymond scale was used to evaluate the degree of immediate postoperative angiography and aneurysm occlusion during follow-up.Univariate analysis was conducted using χ2 test or T test,and the selected predictors were entered into multivariate binary Logistic regression model.Results:The overall incidence of perioperative complications was 11.1%(10/90)and the mortality was 4.4%(4/90).Immediate postoperative angiography was performed in 6cases of Raymond Grade I;6 cases of Raymond Ⅱ grade;78 cases were Raymond Ⅲgrade.The 62 patients were followed up clinically and radiographically for 2-35 months,with an average follow-up of(9.18±6.30)months.m RS Score was 0-1.Angiographic aneurysm was cured in 77.4%(48/62),improved/stabilized in 21%(13/62),and recanalized in 1.6%(1/62).Univariate analysis showed that aneurysm diameter,location in the basilar artery,stent coverage of AICA and other factors were associated with perioperative complications.The follow-up time was prolonged and the rate of aneurysm occlusion was increased.Binary Logistic regression analysis showed that P values of the included factors were all greater than 0.05,without statistical significance.Conclusion:Endovascular treatment of Vertebral Basilar Trunk Large Aneurysms(VBTLAs)is challenging.Blood flow guide devices are an important method in the treatment of unruptured VBTLAs,and have high safety and effectiveness.The diameter of the aneurysm,whether the basilar artery was involved,and whether the stent covered AICA during surgery were related factors for complications.The rate of aneurysm occlusion increased with the extension of follow-up time.For VBTLAs patients to be treated with flow-guided devices,the size of aneurysm and its relationship with important branches should be evaluated in detail,management of operation period should be strengthened,and postoperative follow-up should be performed closely.