F low diverters are now routinely used at several institutions for treatment of an expanding population of intracranial aneurysms. 7,8,13,18 The Pipeline Embolization Device (PED) is a flow diverter that has received significant attention in the recent literature. 7,17,18 The PED was approved by the FDA in 2011 for treatment of large and giant wide-necked aneurysms of the internal carotid artery (ICA). In most series the PED was used for the treatment of large, giant, complex, and fusiform aneurysms, with favorable results. Many investigators, however, remain wary of flow diverters, citing the lack of long-term safety data as well as the risk of distal parenchymal hemorrhage and delayed aneurysm rupture.Currently, there are few data on the use of the PED in small aneurysms amenable to conventional endovascular techniques. 1,14,19,20 Therefore, the safety and efficacy of the device in this subgroup remains unknown. We present the results of the largest series of small intracranial aneurysms treated with the PED to date.
Methods
Study DesignThis is a retrospective review of a single-center experience with use of the PED to treat small intracranial aneurysms. The study protocol was approved by the Thomas Jefferson University Institutional Review Board.abbreviatioNS ICA = internal carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; PED = Pipeline Embolization Device; SAH = subarachnoid hemorrhage. obJect Flow diverters are increasingly used for treatment of intracranial aneurysms. In most series, the Pipeline Embolization Device (PED) was used for the treatment of large, giant, complex, and fusiform aneurysms. Little is known about the use of the PED in small aneurysms. The purpose of this study was to assess the safety and efficacy of the PED in small aneurysms (≤ 7 mm). MethoDS A total of 100 consecutive patients were treated with the PED at the authors' institution between May 2011 and September 2013. Data on procedural safety and efficacy were retrospectively collected. reSultS The mean aneurysm size was 5.2 ± 1.5 mm. Seven patients (7%) had sustained a subarachnoid hemorrhage. All except 5 aneurysms (95%) arose from the anterior circulation. The number of PEDs used was 1.2 per aneurysm. Symptomatic procedure-related complications occurred in 3 patients (3%): 1 distal parenchymal hemorrhage that was managed conservatively and 2 ischemic events. At the latest follow-up (mean 6.3 months), 54 (72%) aneurysms were completely occluded (100%), 10 (13%) were nearly completely occluded (≥ 90%), and 11 (15%) were incompletely occluded (< 90%). Six aneurysms (8%) required further treatment. Increasing aneurysm size (OR 3.8, 95% CI 0.99-14; p = 0.05) predicted retreatment. All patients achieved a favorable outcome (modified Rankin Scale Score 0-2) at follow-up. coNcluSioNS In this study, treatment of small aneurysms with the PED was associated with low complication rates and high aneurysm occlusion rates. These findings suggest that the PED is a safe and effective alternative to conventional endovasc...
