Introduction: The Pipeline embolization device (PED) has gained acceptance in the endovascular community for use in treatment of complex intracranial aneurysms not amenable to conventional treatment. Long-term follow-up of the device beyond 6 months is not well represented in literature. We present our to-date experience and follow-up with the device.
Methods: Data from 23 patients treated between March 2009 and July 2013 was prospectively collected and retrospectively reviewed. Patients were treated by two surgeons. Patients were pre-loaded with aspirin and clopidogrel and heparinized intra-operatively. All cases were performed under general anesthetic.
Results: A total of 45 devices were deployed successfully for 23 aneurysms in 23 patients. Mean angiographic follow-up of 16.7 months showed angiographic cure in 65.2% with residual filling in 26.1%. Mean clinical follow-up at a mean of 18 months showed good clinical outcome in 20 (modified Rankin score of 0-2) and poor clinical outcome in 3. Overall mortality was 13%. Symptomatic stroke occurred in 4.3%. In-stent stenosis occurred in 8.7%.
Conclusions: The PED has a role in treating aneurysms not amenable to coil embolization or open surgical clip ligation. The high morbidity and mortality associated with these devices may relate to complexity of the treated aneurysms.
Patient Care: Our experience will contribute to the body of literature on outcomes with treating complex aneurysms with the Pipeline embolization device.
Learning Objectives: By the conclusion of the session, participants should be able to: 1) Describe the principles of flow diversion in treating intracranial aneurysms, 2) Understand the Saskatchewan pipeline experience, 3) Discuss appropriate use of the pipeline embolization device in treatment paradigms.