Introduction: The biggest downside of cerebral aneurysm coiling is the high recurrence rate and re-treatments needed. With the increasing number of aneurysm recurrences after failed coiling procedures, the best re-treatment strategy remains unknown. To assess the efficacy and safety of the pipeline embolization device (PED) in the treatment of recurrent previously coiled aneurysms.

Methods: 32 patients who underwent treatment with the PED of a recurrent previously coiled aneurysm were retrospectively identified. Efficacy was assessed in terms of angiographic occlusion at the latest cerebral angiogram, recurrence and re-treatment rates after PED placement and clinical outcome at the latest follow-up. Safety was assessed by looking at the complications, morbidity and mortality after PED treatment.

Results: The mean patient age was 53 years. The mean percent recurrence from coiling to PED placement was 34%. The mean time from coiling to PED placement was 40 months. PED treatment resulted in complete aneurysm occlusion in 76.7% of patients and near complete aneurysm occlusion (=90%) in 10%, for a total rate of complete and near complete aneurysm occlusion of 86.7%. All patients, including those with incomplete aneurysm occlusion had a significant reduction in aneurysm size. Two aneurysms required another re-treatment after PED placement (6.2%). 97% of patients had a good clinical outcome. Complications were observed in one patient (3%). This patient suffered an intracerebral hemorrhage. There were no mortalities.

Conclusions: The use of the PED in the management of recurrent, previously coiled aneurysms is safe and effective in achieving aneurysm occlusion.

Patient Care: It will provide physicians with a better understanding of the role of the pipeline embolization device in the management of recurrent aneurysms that were initially coiled, which will help in making the best decision to manage these recurrent aneurysms.

Learning Objectives: To evaluate the efficacy and safety of the pipeline embolization device (PED) in the treatment of recurrent previously coiled cerebral aneurysms.

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