Introduction While the Pipeline Embolization Device (PED, Medtronic) is safe and effective in the treatment of intracranial aneurysms in adults, less is known about its safety and effectiveness in pediatric patients. We aim to report clinical outcomes in patients aged 18 or younger undergoing flow diversion with PED for intracranial aneurysms.

Methods PubMed, Embase, and Scopus were searched for reports of pediatric patients treated with PED. Disaggregated data was available for 44 pediatric patients with 48 aneurysms. Data regarding demographics, aneurysm characteristics, treatment, follow-up, clinical outcomes, and complications were collected.

Results The average age of patients was 10.5 ± 4.3 years, 47.8% of whom were male, while 34.1% were female, and the sex of 18.1% was not reported. A total of 23 aneurysms (52.2%) were in the posterior circulation. Fourteen aneurysms (29.2%) were fusiform, and 12 (25.0%) were dissecting. Fifteen aneurysms (31.3%) were giant, 14 (29.2%) were small, and 9 (18.9%) were large. Fourteen aneurysms (29.2%) presented with mass effect, followed by 11 (22.9%) with subarachnoid hemorrhage, and 6 (12.5%) each with headache and recurrence. The number of PEDs used for an aneurysm was 2.0 ± 1.5, and 10 aneurysms (20.8%) were treated with adjunct coiling. The average imaging and clinical follow-up for the aneurysms were 10.1 ± 7.9 and 10.5 ± 8.1 months, respectively. Thirty-four aneurysms (70.8%) were completely occluded. Four patients (10.0%) experienced complications, including one death, recurrence, brainstem compression, and in-stent stenosis.

Conclusions PED is safe and effective for intracranial aneurysm treatment in pediatric patients. Proper guidelines regarding use of PED in children should be created.

Disclosures N. Shlobin: None. M. Potts: None.