Immediate procedural outcomes in 35 consecutive pipeline embolization cases: a single-center, single-user experience
- Geoffrey P Colby1,
- Li-Mei Lin1,
- Juan F Gomez2,
- Alexandra R Paul3,
- Judy Huang1,
- Rafael J Tamargo1,
- Alexander L Coon1
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- 2Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 3Department of Neurosurgery, Albany Medical Center, Albany, New York, USA
- Correspondence to Dr Alexander L Coon, Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 8-181, Baltimore, MD 21287, USA;
Contributors ALC, GPC, L-ML and JFG conceptualized the study, executed the procedures and acquired the data. JH and RJT assisted with the analysis and interpretation of the data. GPC and ARP drafted the article and revised it critically. All authors gave final approval of the version to be published.
- Received 5 February 2012
- Revised 5 March 2012
- Accepted 7 March 2012
- Published Online First 29 March 2012
Background and objective Flow diverters are an exciting new class of endovascular devices that treat aneurysms by curative reconstruction of the parent artery. The Pipeline embolization device (PED) is the first FDA-approved intracranial flow diverting device available in the USA. This paper presents periprocedural results with the device in a series of 35 consecutive cases.
Methods All patients who underwent PED treatment of an intracranial aneurysm at our institution following FDA approval of the device in April 2011 were included in the series. Patient demographics, aneurysm characteristics, procedural details and technical and clinical outcomes were analyzed.
Results Thirty-four patients (age range 23–78 years, mean 56.4 years) with 41 unruptured aneurysms (37 anterior circulation, four posterior circulation, mean size 11.4 mm, 20/21 large or giant) were treated with the PED in 35 cases (one patient had bilateral aneurysms treated on 2 separate occasions). Thirty-four of 35 cases (97%) were successfully completed. A total of 64 PEDs were implanted, with a mean number of 1.2 PEDs implanted per anterior circulation cases and 6.5 per posterior circulation cases. A single PED was implanted in 73% of cases. Immediate flow disruption occurred in 97% of the cases. The overall rate of major stroke or mortality was 3% (1/35 patients). Minor stroke, cranial nerve palsy, transient neurological deficit and groin complication occurred in one patient each (3% each, 12% total).
Conclusion Treatment of cerebral aneurysms with the PED carries an acceptable risk profile when a rigorous and uniform technique is used. Although the long-term results will need to be analyzed, the immediate procedural outcomes in the study series using this technique appear quite promising.
- flow diversion
- pipeline embolization device
- arteriovenous malformation
- flow diverter
- liquid embolic material
- arteriovenous malformation
Competing interests ALC is a proctor for the Pipeline embolization device (Covidien, Mansfield, Massachusetts, USA) and consultant for Covidien. The other authors have no conflict of interest. No author received financial support in conjunction with the generation of this submission.
Ethics approval This study was conducted with the approval of the Institutional Review Board of Johns Hopkins Hospital.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.