Comparison Between Pipeline Embolization Device and Derivo Embolization Device for the Treatment of Unruptured Cerebral Aneurysms: A Single-Center Analysis

Abstract

Background: The introduction of flow diverters (FDs) has greatly enhanced the treatment of cerebral aneurysms. This study compares two FDs, the Pipeline Embolization Device (PED) and the Derivo Embolization Device (DED), in terms of technical, angiographic and clinical aspects. Methods: A total of 103 patients with unruptured aneurysms were treated with the PED (n = 56) and DED (n = 47) between 2012 and 2019. Aneurysm occlusion, procedural complications, occurrence of In-stent stenosis and clinical outcome were evaluated retrospectively. Results: Implantation of the flow diverters was technically successful in all patients. There were no significant differences between baseline characteristics and aneurysm morphology. Angiographic follow-up was available with a median short-term follow-up of 3 months and a median long-term follow-up time of 16 months. Adequate aneurysm occlusion at long-term follow-up was substantially but not significantly greater with the DED (95.8%, 45/47) compared to the PED (87.5%, 49/56) (p = 0.084). In-stent stenoses were significantly less frequent with the DED (29.8%; 14/47) than with the PED (53.6%, 30/57) at short-term follow-up (p = 0.017), although moderate and asymptomatic overall. Thromboembolic or hemorrhagic events occurred in 10.7% (6/56) of cases with the PED and 8.5% (4/47) with the DED (p = 0.752). Morbidity rates were similar between devices (PED 3.6% (2/56), DED 2.1% (1/47), p = 1.0). There was no procedural mortality. Conclusions: Clinical outcomes and complications were comparable between the PED and DED while aneurysm occlusion was considerably greater at long-term follow-up and in-stent stenosis significantly less frequent at short-term follow-up with the DED. The surface-modified design of the DED may contribute to reduced thrombogenicity and early advantages in preventing in-stent stenosis. Further comparative studies are necessary to investigate these findings, particularly comparing surface-modified flow diverters with newer-generation devices featuring true coatings.