Introduction: Flow diverters are an exciting new class of endovascular devices that treat aneurysms by curative reconstruction of the parent artery. The Pipeline embolization device (PED; Covidien Vascular Therapies, Mansfield, Massachusets, USA) is the first FDA-approved intracranial flow diverting device available in the USA. We present our periprocedural results in a series of 35 consecutive PED cases.
Methods: All patients who underwent PED treatment of an intracranial aneurysm at our institution following FDA approval of the device in April 2011 were included in the series. Patient demographics, aneurysm characteristics, procedural details, and technical and clinical outcomes were analyzed.
Results: Thirty-four patients (range 23 - 78 years, mean age 56.4 years) with 41 unruptured aneurysms (37 anterior circulation, 4 posterior circulation, mean size 11.4 mm, 20/41 large or giant) were treated with the PED. Thirty-four of 35 cases (97%) were successfully completed. A total of 64 PEDs were implanted, with the mean number of PEDs implanted per anterior and posterior circulation cases of 1.2 PEDs and 6.5 PEDs, respectively. A single PED was implanted in 73% of cases. Immediate flow disruption occurred in 97% of the cases. The overall rate of major stroke or mortality was 3% (1 of 35 patients). Minor stroke, cranial nerve palsy, transient neurological deficit, and groin complication occurred in one patient each (3% each, 12% total).
Conclusions: Treatment of cerebral aneurysms with the PED carries an acceptable risk profile when a rigorous and uniform technique is used. Although the long-term results will need to be analyzed, the immediate procedural outcomes in our series using this technique appear quite promising.
Patient Care: Flow diversion is an important new tool for the treatment of intracranial aneurysms, particularly large and giant aneurysms. Outcome studies and investigations into the necessary technical nuances required for safe and effective use of these devices is essential. Establishment of protocols and guidelines for proper use via this type of research will provide both immediate and future improvements in patient care.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Describe the importance of flow diversion as a new treatment for intracranial aneurysms, 2) Discuss and understand the periprocedural results of such procedures using the Pipeline embolization device, 3) Understand the risks of flow diversion using the Pipeline device, and 4) Understand some of the technical nuances required for successful performance of these procedures.