Introduction The Pipeline embolization device (PED) is an efficacious endovascular option for anterior circulation aneurysms with broad-based, fusiform involvement of the parent vessel. Endovascular treatment of such aneurysms has classically involved coil embolization with adjunctive use of a stent. However, stent-coiling can incur significant equipment and implant costs, particularly if the aneurysm is large and numerous coils are used. The authors hypothesized that PED embolization is a cost effective alternative to stent-assisted coiling.

Methods A prospective single-center aneurysm database was retrospectively reviewed to identify consecutive patients with anterior circulation aneurysms who underwent aneurysm treatment with the PED or by single-staged stent-assisted coiling. Thirty consecutive patients were selected in each group, for a total of 60 patients. The hospital cost of equipment and implants were analyzed and compared for each group.

Results Hospital equipment and implant costs were analyzed for 30 consecutive aneurysm treatments with the PED (mean aneurysm size 9.8 mm) vs 30 consecutive cases of stent-assisted coiling (mean aneurysm size 7.3 mm). The total combined cost of proximal access/guide catheters, microcatheters, and microwires were equivalent between the two groups (PED $3057±$102 vs stent-coiling $3199±$126, p=0.3927). The cost of implants, however, was significantly lower in the PED group ($13 175±$726 vs $19 069±$2015, p=0.0126), despite this group having a larger mean aneurysm size. Furthermore, the total cost (equipment, implants, and adjunctive devices) was significantly lower for the PED group vs the stent-coiling group ($16 445±$735 vs $22 145±$2022, p=0.0181), representing a 25.7% cost reduction. This represents a 27.1% reduction in the cost per millimeter of aneurysm treated in the PED group ($2261±$299) vs the stent-coiling group ($3102±$193, p=0.0202).

Conclusion Treatment of anterior circulation aneurysms by flow diversion with the PED is a cost effective alternative to traditional stent-assisted coiling.

Competing interests G Colby: None. L Lin: None. A Paul: None. J Huang: None. R Tamargo: None. A Coon: Covidien.