Clinical neurology and neurosurgery · 2025
Association between fetal posterior communicating artery Anatomy and pipeline embolization device treatment efficacy: A propensity score-weighted cohort study.
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Xue Xiaopeng, Liu Hongyi, Sun Mingjiang, Tong Xin, Liu Aihua
Аннотация
PURPOSE: The angiographic efficacy of the Pipeline Embolization Device (PED) for unruptured, saccular fetal posterior communicating artery (PComA) aneurysms remains controversial, and available data on functional outcomes and complications are limited. This study aimed to assess the association between fetal PComA anatomy and PED treatment efficacy.
METHODS: We retrospectively enrolled patients with unruptured, saccular PComA aneurysms treated with PED between January 2015 and December 2020. To mitigate confounding, inverse probability weighting based on propensity scores was applied, and covariate balance was evaluated using standardized mean differences. Sensitivity analyses included propensity score matching, multivariable regression, and a restricted analysis of patients with ≥ 12-month angiographic follow-up or treated with PED alone.
RESULTS: Among 742 consecutive patients with 898 PED-treated aneurysms, 93 were PComA aneurysms, including 21 fetal-type cases. Incomplete occlusion rates were similar between fetal and non-fetal groups in both unadjusted and weighted analyses (22.2 % vs 23.2 %, P > 0.999; weighted 27.8 % vs 22.5 %, P = 0.713). There were no significant between-group differences in functional outcomes or overall complications. Consistent results were obtained in propensity score-matched and multivariable regression analyses, as well as in the sensitivity analysis restricted to patients treated with PED alone. Most fetal PComA vessels remained patent (94.4 %), and observed occlusions were clinically silent, likely due to collateral supply from the posterior cerebral artery (PCA).
CONCLUSION: Presence of a fetal PComA was not associated with worse angiographic or clinical prognosis following PED treatment. Consistent results in PED-only analysis suggest that adjunctive coiling did not substantially influence the main findings. Given the limited number of events, these results should be interpreted cautiously.
METHODS: We retrospectively enrolled patients with unruptured, saccular PComA aneurysms treated with PED between January 2015 and December 2020. To mitigate confounding, inverse probability weighting based on propensity scores was applied, and covariate balance was evaluated using standardized mean differences. Sensitivity analyses included propensity score matching, multivariable regression, and a restricted analysis of patients with ≥ 12-month angiographic follow-up or treated with PED alone.
RESULTS: Among 742 consecutive patients with 898 PED-treated aneurysms, 93 were PComA aneurysms, including 21 fetal-type cases. Incomplete occlusion rates were similar between fetal and non-fetal groups in both unadjusted and weighted analyses (22.2 % vs 23.2 %, P > 0.999; weighted 27.8 % vs 22.5 %, P = 0.713). There were no significant between-group differences in functional outcomes or overall complications. Consistent results were obtained in propensity score-matched and multivariable regression analyses, as well as in the sensitivity analysis restricted to patients treated with PED alone. Most fetal PComA vessels remained patent (94.4 %), and observed occlusions were clinically silent, likely due to collateral supply from the posterior cerebral artery (PCA).
CONCLUSION: Presence of a fetal PComA was not associated with worse angiographic or clinical prognosis following PED treatment. Consistent results in PED-only analysis suggest that adjunctive coiling did not substantially influence the main findings. Given the limited number of events, these results should be interpreted cautiously.