Pipeline versus Tubridge Embolization Devices for Intracranial Aneurysms: A Systematic Review and Meta-analysis of Double-arm Studies

Introduction: Flow diverters (FDs) have recently become a popular intervention for intracranial aneurysms (IAs). Pipeline embolization devices (PED) and Tubridge embolization devices (TED) are two novel FDs utilized in managing IAs. In this systematic review and meta-analysis, we aimed to compare the efficacy and safety of PED and TED in double-arm studies.

Methods: On July 17th, 2024, a systematic literature search was conducted in PubMed, Embase, Scopus, and Web of Science. The meta-analyses, sensitivity analysis, publication bias, and meta-regression were performed through the R program.

Results: Five studies with 1504 patients were included. Our meta-analysis revealed an odds ratio (OR) of 1.26 (95% CI: 0.94 – 1.68) for complete occlusion in favor of PED (P = 0.11). The PED demonstrated a more significant effect on the Modified Rankin Scale (mRS) (SMD = -2.15 [95% CI: -2.74 - -1.55]) in comparison with the TED effect (SMD = -1.02 [95% CI: -3.66 – 1.63]) (P = 0.41). The OR of major complications (OR: 0.49, [95% CI: 0.16 – 1.51], P = 0.22) was lower in the PED group. The OR of major ischemic stroke occurrence was significantly lower in PED compared to TED (OR: 0.22, [95% CI: 0.08 – 0.91], P = 0.04). Despite the higher OR of hemorrhagic complication in PED patients (OR: 1.70, [95% CI: 0.41 – 7.05]), the difference is insignificant (P = 0.50).

Conclusion : Our systematic review and meta-analysis demonstrated that PED and TED were associated with favorable angiographic and clinical outcomes and relatively low adverse events.