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Estimating the proportion of intracranial aneurysms likely to be amenable to treatment with the pipeline embolization device
  1. Waleed Brinjikji,
  2. Harry J Cloft,
  3. David Fiorella,
  4. Giuseppe Lanzino,
  5. David F Kallmes
  1. Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr David F Kallmes, Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; kallmes.david{at}


Objective A study was undertaken to estimate the fraction of intracranial aneurysms that might be amenable to treatment with the pipeline embolization device (PED), a current flow diverter device, and to determine the types of aneurysms that are probably not amenable to treatment with this device.

Methods A retrospective analysis of 200 consecutive intracranial aneurysms as seen on three-dimensional rotational angiography images was conducted. Based on aneurysm and parent artery morphology, four independent observers experienced in the use of the PED judged the likelihood that a given aneurysm could theoretically be treated with one or more PED using a 5-point scale: grades 1 and 2 indicated amenability to treatment with multiple devices; grade 3 indicated amenability to treatment with one device; and grades 4 and 5 indicated the aneurysm would not be amenable to treatment with the PED. Aneurysms were analyzed on the basis of anatomical factors only. Rupture status was not considered. Interobserver agreement was determined.

Results 94 of 200 aneurysms (47%) were judged to be likely to be amenable to treatment with the PED; 50 cases (25%) were judged to be amenable to the use of multiple overlapping devices while, in 44 cases (22%), coverage with a single device was preferred. There was a significant relationship between the location of the aneurysm and the grade of the aneurysm (p<0.0001).

Conclusion On the basis of anatomical configuration, nearly half of the aneurysms in this study were likely to be amenable to treatment with the PED.

  • Aneurysm
  • guidewire
  • history
  • face
  • flow diverter
  • artery
  • spinal cord
  • thrombectomy
  • navigation
  • complication

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  • Competing interests WB and HJC have no competing interests. DF consults (Pipeline proctor) for ev3 Codmanand Nfocus. He received institutional research grant funding and is an unpaid consultant for Microvention. GL receives unrestricted educational grants from ev3 and serves on the advisory board for Actelion Pharmaceuticals. DFK receives research support from ev3, Microventions Inc, Chestnut Inc, and Micrus Endovascular Inc.

  • Ethics approval Ethics approval was provided by IRB at Mayo Clinic, Rochester, MN.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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