147 Views

Comparison of thromboembolic events between PED Shield and PED/ PED Flex: A Propensity Score–Matched Analysis

Friday, May 3, 2024

Presenting Author(s)

Felipe Ramirez Velandia

Research Trainee
Beth Israel Deaconess Medical Center, Harvard Medical School. Boston, MA, United States.
Boston, MA, US

Co-Author(s)

Alejandro Enriquez-Marulanda, MD

Resident, Neurosurgical Division, Beth Israel Deaconess Medical Center
Harvard Medical School
Boston, MA, US
Jean Filo, n/a

Medical Student
Harvard Medical School, United States
Thomas B. Fodor, BSc

Research Trainee
Beth Israel Deaconess Medical Center
JG

Justin H. Granstein, MD

Neurointerventional Surgery
Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA, United States., United States
SM

Sandeep Muram, MD, n/a

Fellow, Neurosurgical Division
Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA, United States.
Calgary, Alberta, United States
Christopher S. Ogilvy, MD

Endovascular and Operative Neurovascular Surgery
BIDMC Brain Aneurysm Institute, Neurosurgical Division, Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA, United States.
Boston, Massachusetts, United States
Daniel Sconzo, BA

Research Trainee
BMC Neurosurgery, Neurosurgical Division, Beth Israel Deaconess Medical Center. Boston, MA, United States.
MS

Max Shutran, MD, n/a (he/him/his)

Endovascular and Operative Neurovascular Surgery
BIDMC Brain Aneurysm Institute, Neurosurgical Division, Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA, United States.
Boston, Massachusetts, United States
PT

Philipp Taussky, MD

Endovascular and Operative Neurovascular Surgery
Neurosurgical Division, Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA, United States., United States
Michael Young, D.O.

Cerebrovascular Fellow, Neurosurgical Division
Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA, United States.
Boston, Massachusetts, United States

Introduction: The Pipeline Flex with Shield technology is a third-generation flow-diverter designed to decrease thrombogenicity through phosphorylcholine coverage. In this study we aim to compare the rate of thromboembolic events in PED Shield with PED and PED Flex trough propensity score matching.

Methods: We conducted a retrospective analysis of aneurysms treated with PED/ PED Flex and PED Shield between 2013 and 2023 at a single academic institution. Patients were matched through propensity score by controlling for confounding factors including smoking history, diabetes, prior subarachnoid hemorrhage, mRS pre-treatment, maximal diameter, platelet function test, and clopidogrel or aspirin resistance. After matching, we evaluated for periprocedural and postoperative thromboembolic events. Data analysis was performed using Stata 14.

Results: A total of 543 patients with 707 aneurysms treated in 605 procedures were included in the analysis. 156 aneurysms were treated with PED Shield (22.07%) and 551 were treated with PED or PED Flex (77.93%). Propensity score matching resulted in 90 matched pairs. The rate of thromboembolic events was 4.44 % for PED Shield and 8.89 % for PED / PED Flex (p value = 0.232). Complete occlusion at first (p value = 0.409), and last imaging follow up (p value = 0.71), in-stent stenosis (p value = 0.24), hemorrhagic complications (p=0.79), and functional outcome (p value = 0.19) were comparable for PED Shield and PED / PED Flex.

Conclusion : To the best of our knowledge, this study includes the largest patient cohort to evaluate thromboembolic events between PED Shield and first and second-generation PED using propensity score matching. Our findings suggest a trend toward lower thromboembolic events with PED Shield, though this difference did not reach statistical significance.