Outcomes and complications after the use of the pipeline embolization device in the treatment of intracranial aneurysms of the posterior circulation: A systematic review and meta-analysis

Abstract Background and purpose: The use of the pipeline embolization device (PED) for posterior circulation aneurysms remains controversial. In this meta-analysis, we aimed to explore the safety and efficacy of PED for these aneurysms. Meta regression was used to identify predictors for incomplete aneurysm occlusion and procedure-related complications. Methods PubMed, Web of Science, and OVID databases were searched to identify all published references evaluating the treatment effect of PED for posterior circulation aneurysms. Only studies written in English, reporting original data, and including more than 10 cases were considered for inclusion. Patient demographics, aneurysm characteristics, angiographic, and clinical outcomes were extracted. A random effects model was adopted to pool the obliteration rates and complications rates across selected studies. Finally, we conducted meta-regression analysis to identify the predictors of the angiographic outcomes. Results 12 studies, including 358 patients with 365 aneurysms were included. The pooled complete aneurysm obliteration rate was 82% (95% confidence interval [CI], 73%-90%) and the pooled procedure-related complication rate was 18% (95% CI, 14%-22%). Increasing age predicted incomplete obliteration of aneurysms after PED treatment in these patients ( P =0.01). Conclusions PED is an alternative to treat intracranial aneurysms of the posterior circulation, achieving high complete occlusion rates, but less effective in senile patients. However, the risk of procedure-related complications is not negligible. Further larger and long-term follow-up studies are needed before definitive conclusions might be drawn.