J NeuroIntervent Surg 1:56-65 doi:10.1136/jnis.2009.000083
  • New devices

Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms

  1. P K Nelson6
  1. 1Division of Neurosurgery, State University of New York at Stony Brook, Stony Brook, New York, USA
  2. 2Division of Neurosurgery, ENERI Medical Institute, Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Buenos Aires, Argentina
  3. 3Division of Neurosurgery and Neuroradiology, National Institute of Neurosurgery, Budapest, Hungary
  4. 4Division of Neurosurgery, Royal University Hospital, Saskatchewan, Canada
  5. 5Division of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  6. 6Division of Neuroradiology and Neurosurgery, New York University, New York, New York, USA
  1. Correspondence to
    Dr D Fiorella, Department of Neurosurgery, Cerebrovascular Center, State University of New York at Stony Brook, Health Sciences Center T-12 080, Stony Brook, New York 11794–8121, USA; dfiorell{at}
  • Received 1 April 2009
  • Accepted 3 April 2009
  • Published Online First 17 June 2009


Endovascular, endosaccular, coil embolization has emerged as an established therapy for both ruptured and unruptured cerebral aneurysms. However, many aneurysms are not cured using conventional endovascular techniques. Coil embolization often results in incomplete aneurysm occlusion or recanalization in the ensuing months after treatment. The Pipeline embolization device (PED; Chestnut Medical) represents a new generation endoluminal implant which is designed to treat aneurysms by reconstructing the diseased parent artery. Immediately after implantation, the PED functions to divert flow from the aneurysm, creating an environment conducive to thrombosis. With time, the PED is incorporated into the vessel wall as neointimal–endothelial overgrowth occurs along the construct. Ultimately, this process results in the durable complete exclusion of the aneurysm from the cerebrovasculature and a definitive endoluminal reconstruction of the diseased parent artery.



  • Competing interests PN is a consultant and stockholder in Chestnut Medical.


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