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Original research
New Pipeline Flex device: initial experience and technical nuances
  1. Vitor Mendes Pereira1,2,3,
  2. Michael Kelly4,
  3. Pedro Vega5,
  4. Eduardo Murias5,
  5. Hasan Yilmaz1,
  6. Gorislav Erceg1,
  7. Alain Pellaton1,
  8. Karl-olof Lovblad1,
  9. Timo Krings2,3
  1. 1Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
  2. 2Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
  3. 3Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
  4. 4Division of Neurosurgery, Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, Canada
  5. 5Department of Interventional Neuroradiology, Oviedo, Spain
  1. Correspondence to Dr Vitor Mendes Pereira, Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, 3MCL-436, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8; vitormpbr{at}hotmail.com

Abstract

Background Flow diverter stents (FDS) have been described as a breakthrough in the treatment of intracranial aneurysms. Of the various flow diverter models, the Pipeline device has been the main approved and used device, with established and good long-term results.

Objective To present the first series of patients treated with its new version, the Pipeline Flex device. This has kept the same device design and configuration but redesigned and completely modified the delivery system.

Methods In this technical report, we include 10 consecutive patients harboring 12 saccular aneurysms of the anterior circulation. We report the main changes on the system, immediate results, and technical nuances with illustrative cases.

Results We implanted 12 devices, including 11 Pipeline Flex and one Pipeline device. We used the old version in one case that required a second layer with a short length not available in the Pipeline Flex size range. All attempts at treatment were successful and no device was discharged or removed. Recovery was required or used in half of the cases with good or excellent performance, except in one case that presented with multiple proximal loops and tight curves. We had two transitory events without ischemic lesions on MRI that recovered 1 and 4 h after all patients were discharged home asymptomatic.

Conclusions Pipeline Flex represents a major advance in FDS technology. The redesigned system has significantly improved the deployment of the Pipeline stent, by enabling the operator to resheath the device. It has the potential to continue revolutionizing the endovascular approach for intracranial aneurysms.

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