{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T11:00:02Z","timestamp":1783767602346,"version":"3.55.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Pseudoaneurysms (PSAs) are complex vascular lesions. Flow diversion has been proposed as an alternative treatment to parent artery occlusion that preserves laminar flow. The authors of the present study investigated the safety and short-term (< 1 year) and long-term (\u2265 1 year) aneurysm occlusion rates following the treatment of intracranial and extracranial PSAs using the Pipeline embolization device (PED).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n An electronic database search for full-text English-language articles in Ovid MEDLINE and Epub Ahead of Print, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus was conducted following the PRISMA guidelines. Studies of any design including at least 4 patients with intracranial or extracranial PSAs treated using a PED were included in this analysis. The primary outcome of interest was the rate of peri- and postprocedural complications. Secondarily, the authors analyzed the incidence of complete aneurysm occlusion.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 90 patients with 96 PSAs across 9 studies were included. The mean age was 38.2 (SD 15.14) years, and 37.8% of the patients were women. The mean PSA size was 4.9 mm. Most PSAs were unruptured, and the most common etiology was trauma (n = 32, 35.5%), followed by spontaneous formation (n = 21, 23.3%) and iatrogenic injury (n = 19, 21.1%). Among the 51 (53.1%) intracranial and 45 (46.9%) extracranial PSAs were 19 (19.8%) dissecting PSAs. Sixty-six (77.6%) PSAs were in the internal carotid artery and 10 (11.8%) in the vertebral artery. Thirty-three (34.4%) PSAs were treated with \u2265 2 devices, and 8 (8.3%) underwent adjunctive coiling. The mean clinical and angiographic follow-up durations were 10.7 and 12.9 months, respectively. The short-term (< 1 year) and long-term (\u2265 1 year) complete occlusion rates were 79% (95% CI 66%\u201388%, p = 0.82) and 84% (95% CI 70%\u201392%, p = 0.95), respectively. Complication rates were 8% for iatrogenic dissection (95% CI 3%\u201316%, p = 0.94), 10% for silent thromboembolism (95% CI 5%\u201321%, p = 0.77), and 12% for symptomatic thromboembolism (95% CI 6%\u201323%, p = 0.48). No treatment-related hemorrhage was observed. The overall mortality rate at the last follow-up was 14%.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The complete occlusion rate for PSAs treated with the PED was high and increased over time. Although postprocedural complications and mortality were not insignificant, flow diversion represents a reasonably safe option for managing these complex lesions.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2023.2.focus22644","type":"journal-article","created":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T07:20:40Z","timestamp":1682925640000},"page":"E5","source":"Crossref","is-referenced-by-count":9,"title":["Flow diversion using the Pipeline embolization device for intracranial and extracranial pseudoaneurysms: a systematic review and meta-analysis of the literature"],"prefix":"10.3171","volume":"54","author":[{"given":"Elena","family":"Greco","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Radiology, Mayo Clinic, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Rios-Zermeno","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda, Mexico City, Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Karim","family":"Ghaith","sequence":"additional","affiliation":[{"name":"Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umme Habiba","family":"Faisal","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, Kalyani, West Bengal, India; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anshit","family":"Goyal","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwaseun O.","family":"Akinduro","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Kashyap","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Miller","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Radiology, Mayo Clinic, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Graepel","sequence":"additional","affiliation":[{"name":"Department of Education, Division of Biomedical and Scientific Visualization, Mayo Foundation for Medical Education and Research, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik H.","family":"Middlebrooks","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Radiology, Mayo Clinic, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukhwinder S.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Radiology, Mayo Clinic, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabih G.","family":"Tawk","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"J Neurosurg","first-page":"11","article-title":"Traumatic intracranial aneurysms","volume":"52","author":"Parkinson D","year":"1980","unstructured":"Parkinson D, West M. 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