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Use of the Pipeline embolization device for recurrent and residual cerebral aneurysms: a safety and efficacy analysis with short-term follow-up
  1. Anna Luisa Kühn,
  2. Katyucia de Macedo Rodrigues,
  3. J Diego Lozano,
  4. David E Rex,
  5. Francesco Massari,
  6. Takamitsu Tamura,
  7. Mary Howk,
  8. Christopher Brooks,
  9. Jenna L'Heureux,
  10. Matthew J Gounis,
  11. Ajay K Wakhloo,
  12. Ajit S Puri
  1. Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
  1. Correspondence to Dr Ajit S Puri, Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655, USA; ajit.puri{at}


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
  • Aneurysm
  • Coil
  • Intervention

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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.