Objective Evaluation of the safety and efficacy of the Pipeline embolization device (PED) when used as second-line treatment for recurrent or residual, pretreated ruptured and unruptured intracranial aneurysms (IAs).
Methods Retrospective review of our database to include all patients who were treated with a PED for recurrent or residual IAs following surgical clipping or coiling. We evaluated neurological outcome and angiograms at discharge, 6- and 12-months’ follow-up and assessed intimal hyperplasia at follow-up.
Results Twenty-four patients met our inclusion criteria. Most IAs were located in the anterior circulation (n=21). No change of preprocedure modified Rankin Scale score was seen at discharge or at any scheduled follow-up. Complete or near-complete aneurysm occlusion on 6- and 12-month angiograms was seen in 94.4% (17/18 cases) and 93.3% (14/15 cases), respectively. Complete or near-complete occlusion was seen in 100% of previously ruptured and 85.7% (6/7 cases) and 83.3% (5/6 cases) of previously unruptured cases at the 6- and 12-months’ follow-up, respectively. One case of moderate intimal hyperplasia was observed at 6 months and decreased to mild at the 12-months’ follow-up. No difference in device performance was observed among pretreated unruptured or ruptured IAs.
Conclusions Treatment of recurrent or residual IAs with a PED after previous coiling or clipping is feasible and safe. There is no difference in device performance between ruptured or unruptured IAs.
- Flow Diverter
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Contributors Study design: ALK, AKW, and ASP. Data acquisition: ALK, KdMR, JDL, AKW, DER, FM, MH, CB, JLH, and ASP. Literature research: ALK, KdMR, JDL, DER, FM, TT, and MH. Data analysis and interpretation: ALK, KdMR, MJG, AKW, and ASP. Manuscript preparation: ALK and ASP. Revision of manuscript for important intellectual content: KdMR, JDL, AKW, DER, FM, MJG, MH, CB, TT, and JLH. Approval of final version of manuscript: all authors.
Competing interests MJG is a consultant for Codman Neurovascular and Stryker Neurovascular; research grants: NIH, eV3/Covidien Neurovascular, Codman Neurovascular, Fraunhofer Institute, Wyss Institute, Philips Healthcare, Stryker Neurovascular, Silk Road, Lazarus-Effect. AKW is a consultant for Stryker Neurovascular; research grants: Philips Healthcare, Wyss Institute; speaker: Harvard Postgraduate Course, Miami Cardiovascular Institute. ASP is a consultant for Codman Neurovascular, Stryker Neurovascular, and Covidien; research grant from Stryker Neurovascular and Covidien; speaker: Miami Cardiovascular Institute.
Ethics approval Institutional review board at University of Massachusetts Medical School.
Provenance and peer review Not commissioned; externally peer reviewed.