Safety, efficacy, and short-term follow-up of the use of Pipeline™ Embolization Device in small (<2.5mm) cerebral vessels for aneurysm treatment: single institution experience

Abstract

Our preliminary results show that flow diversion technology is an effective and safe therapy for aneurysms located on small cerebral arteries. Larger studies with long-term follow-up are needed to validate our promising results.

Endovascular flow diversion for treatment of anterior communicating artery region cerebral aneurysms: a single-center cohort of 50 cases

“…While some have speculated in the literature that placing oversized devices in small distal vessels may reduce wall coverage and the flow diversion effect,7 we observed high occlusion rates with the PED in ACoA region aneurysms, consistent with the general population of patients treated with PED in which complete occlusion was achieved in 70–80% at 6 months15 and approaching 90% after more than 1 year after stopping dual antiplatelet therapy 19. In 4/29 patients (14%) treated with single-stage PED, there was interval remodeling with decreased but subtotal aneurysm filling at last follow-up angiogram.…”

“…Certain aneurysm types including blister, broad-based, and very small aneurysms are not easily amenable to coiling. In acutely ruptured aneurysms, interventionists may choose a lighter coil pack or dome-occlusive strategy to secure the aneurysm while minimizing the risk of intraprocedural rupture 7. Coiling is also associated with a small but increased risk of aneurysm recurrence and rebleeding compared with microsurgical clipping 8…”

Off-label uses of the Pipeline embolization device: a review of the literature

“…62 The complication rate was 0%, and of the 6 patients who were available for angiographic follow-up, there was complete aneurysm occlusion in all patients. Martínez-Galdámez et al also looked at the use of PED to treat 25 aneurysms beyond the circle of Willis.…”

A Case of Ruptured Anterior Communicating Artery Aneurysm Treated in Which Residual Aneurysm after Coil Embolization Was Treated by Placement of LVIS Jr. Stent

“…3) In the PUFS study, 1) in which the effect of PED placement in large internal carotid artery aneurysms proximal to the posterior communicating artery was evaluated, high therapeutic efficacy was reported with complete occlusion rates of 86.8% after 1 year, 93.4% after 3 years, and 95.2% after 5 years. However, concerning PED placement in peripheral aneurysms, although a few successful cases have been reported, 4,5) the use of the stent in this situation is not an approved indication at present, and its safety or efficacy has not been clarified.…”