Elsevier

World Neurosurgery

Volume 76, Issues 1–2, July–August 2011, Pages 114-119
World Neurosurgery

Peer-Review Report
Pipeline Flow-Diverter Stent for Endovascular Treatment of Intracranial Aneurysms: Preliminary Experience in 20 Patients with 27 Aneurysms

https://doi.org/10.1016/j.wneu.2011.02.015Get rights and content

Objective

To report our preliminary experience with the Pipeline flow-diverter stent for the endovascular treatment (EVT) of intracranial aneurysms.

Methods

Between September 2009 and October 2010, 20 patients with 27 fusiform or wide-necked unruptured aneurysms were included and treated by Pipeline stent placement alone. Technical issues, immediate findings, delayed complications, and clinical and imaging follow-up at three and six months were assessed.

Results

EVT was successfully performed in all patients. Clinical outcome was excellent in all but one patient who died. This latter patient developed a massive infarct due to a delayed stent thrombosis. Other complications without permanent deficit included one perimesencephalic subarachnoid hemorrhage and one retroperitoneal hematoma. Minor technical issues without clinical consequence were encountered in nine patients and included stent migration, stent misplacement, unanticipated stent shortening, and the impossibility to recapture the distal coil tip of the supporting device. Angiographic follow-up in 19 patients with 25 aneurysms showed 21 complete occlusions, one neck remnant, and three incomplete occlusions. No significant parent artery stenosis was seen.

Conclusion

This study shows that the Pipeline stent is useful for EVT of fusiform and wide-necked intracranial aneurysms. Moreover, the stent is well tolerated with a low rate of intra-stent stenosis at short-term follow-up. However, technical improvements are needed to ensure safe and precise use of the device.

Introduction

Endovascular treatment (EVT) is more and more considered as first-intention treatment of intracranial aneurysms. However, wide-necked and fusiform aneurysms remain technically challenging to treat by the endovascular approach. Self-expandable intracranial stents are increasingly used to treat these complex aneurysms with satisfying clinical and anatomic results (9, 13, 14). These stents are mostly used as bridging-neck devices in combination with coils. Very recently, flow-diverter stents have been developed and they offer the potential of aneurysm occlusion related to flow disruption (1, 3, 5, 7, 8, 10, 11, 12, 15, 16, 17). These stents share the property of forming a high-coverage mesh once expanded that covers the neck and induces thrombosis of the aneurysmal sac while preserving the patency of adjacent small vessels. The Pipeline stent (EV3, Irvine, California, USA) is the first released flow-diverter stent but little information is available in the literature concerning its use (3, 11, 12, 15, 17). The aim of this prospective study was to report our preliminary experience with the Pipeline stent in 20 patients with 27 aneurysms.

Section snippets

Population

Between September 2009 and October 2010, a total of 20 patients with 27 aneurysms were treated by Pipeline stent placement in two hospitals. Therapeutic alternatives were discussed between neurosurgical and neurointerventional teams in a multidisciplinary decision-making process. Indications of treatment with the Pipeline stent were as follows: 1) fusiform or circumferential aneurysms; 2) wide-necked saccular aneurysms (neck >4 mm or neck/sac ratio >0.7). We considered these aneurysms to have a

Endovascular Procedure/Technical Issues

Embolization was successfully performed in all patients (Table 1). A total of 27 Pipeline devices were used and placed. When the stent had to be delivered within a tortuous anatomy (Figure 1), high frictions were encountered but did not prevent from placing the device. No significant procedural complication occurred in the present series. However, minor technical issues were encountered in nine patients, including stent migration, stent misplacement, unanticipated stent shortening, and the

Discussion

This study shows that the Pipeline stent is useful for EVT of complex intracranial aneurysms. The concept of flow diversion appears promising in challenging lesions, including fusiform and wide-necked aneurysms. Moreover, the stent is well tolerated with a low rate of intra-stent stenosis at short-term follow-up.

Conclusion

Our study shows that the Pipeline flow-diverter stent is useful for EVT of complex intracranial aneurysms. Furthermore, the stent is well tolerated with a low rate of intra-stent stenosis at short-term follow-up. However, technical improvements are needed to ensure safer and more precise use of the device.

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Conflict of interest statement: Boris Lubicz is a Proctor and Consultant for EV3 company.

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