Introduction: The use of the pipeline embolization device (PED) in the management of recurrent previously stented cerebral aneurysms has been controversial ever since early reports questioned its role in treating aneurysms with a previous stent placement. The aim of this study is to evaluate the efficacy and safety of the PED in the treatment of recurrent, previously stented aneurysms.

Methods: 16 patients with previously stented recurrent aneurysms who later underwent PED placement were retrospectively identified. Angiographic occlusion at the latest follow-up angiogram, recurrence and retreatment rates after PED placement and clinical outcomes were assessed. Safety was evaluated by analyzing the complications, morbidity and mortality observed after treatment with the PED.

Results: The mean patient age was 55 years. The mean time from stenting to angiographic recurrence was 25 months. PED treatment resulted in complete aneurysm occlusion in 50% of patients and near complete aneurysm occlusion (=90%) in 14.3%, for a total rate of complete and near complete aneurysm occlusion of 64.3%. 2 previously stented aneurysms that were managed with the PED required a second re-treatment (12.5%). 87.5% of patients had a good clinical outcome at the latest follow-up. Complications were observed in 12.5% of patients, both were thromboembolic complications. There were no mortalities.

Conclusions: The use of the PED in the management of previously stented cerebral aneurysms is less effective than the use of this device in non-stented aneurysms. Prior stent placement can worsen the safety and efficacy profile of the PED.

Patient Care: This paper will provide important data on the safety and efficacy of the pipeline embolization device in the management of recurrent cerebral aneurysms that were previously stented.

Learning Objectives: To look at the role of the pipeline embolization device in the management of recurrent previously stented aneurysms.

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