Current status of pipeline embolization device in the treatment of intracranial aneurysms: a review.

OBJECTIVE Pipeline embolization device (PED) implantation is a novel endovascular treatment option for the treatment of intracranial aneurysms. It is emerging as a useful alternative to coiling and to open surgery, and its use is increasing worldwide. We performed a literature review to examine its efficacy, technical challenges, and safety. METHODS PubMed database was used to identify all articles relating to PED. RESULTS The review outlines the indications for PED, its technical aspects, complications, and clinical outcomes. CONCLUSIONS PED offers an alternative to endovascular coiling for aneurysms with complex morphology. The indication for its use has evolved from the limited scope of treatment of giant aneurysms with wide necks to the inclusion of smaller aneurysms. The procedural safety profile of PED is comparable with or possibly superior to balloon-remodeling or stent-assisted coil embolization in specific circumstances. However, questions remain regarding the incidence of post-procedural subarachnoid hemorrhage. Ongoing monitoring and meticulous documentation of PED postimplantation safety is strongly recommended.

[1]  C. Matouk,et al.  The Pipeline Flow-Diverting Stent for Exclusion of Ruptured Intracranial Aneurysms With Difficult Morphologies , 2012, Neurosurgery.

[2]  R. Spetzler,et al.  The Barrow Ruptured Aneurysm Trial. , 2012, Journal of neurosurgery.

[3]  Dong Joon Kim,et al.  Hemorrhagic Complications Related to the Stent‐Remodeled Coil Embolization of Intracranial Aneurysms , 2010, Neurosurgery.

[4]  Peter Sandercock,et al.  For Personal Use. Only Reproduce with Permission from the Lancet Publishing Group , 2022 .

[5]  Sebastian Fischer,et al.  Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections , 2011, Neuroradiology.

[6]  Bernd Turowski,et al.  Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-Stent) , 2010, Neuroradiology.

[7]  D. Nichols,et al.  Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: retrospective review of a 10-year single-center experience. , 2003, AJNR. American journal of neuroradiology.

[8]  H. Woo,et al.  DEFINITIVE RECONSTRUCTION OF CIRCUMFERENTIAL, FUSIFORM INTRACRANIAL ANEURYSMS WITH THE PIPELINE EMBOLIZATION DEVICE , 2008 .

[9]  A. Molyneux.  International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial , 2002, The Lancet.

[10]  T. Becske,et al.  Safety and Efficacy of Adjunctive Balloon Remodeling during Endovascular Treatment of Intracranial Aneurysms: A Literature Review , 2008, American Journal of Neuroradiology.

[11]  L. Pierot.  Flow diverter stents in the treatment of intracranial aneurysms: Where are we? , 2011, Journal of neuroradiology. Journal de neuroradiologie.

[12]  J. Raymond,et al.  Barrow ruptured aneurysm trial. , 2012, Journal of neurosurgery.

[13]  D. Fiorella,et al.  CURATIVE RECONSTRUCTION OF A GIANT MIDBASILAR TRUNK ANEURYSM WITH THE PIPELINE EMBOLIZATION DEVICE , 2009, Neurosurgery.

[14]  K. Lovblad,et al.  Flow-Diverting Stent for Ruptured Intracranial Dissecting Aneurysm of Vertebral Artery , 2012, Neurosurgery.

[15]  R. Rosenwasser,et al.  Endovascular Management of Intracranial Aneurysms: Current Experience and Future Advances , 2006, Neurosurgery.

[16]  Z Kulcsar,et al.  Treatment of Intracranial Aneurysms by Functional Reconstruction of the Parent Artery: The Budapest Experience with the Pipeline Embolization Device , 2010, American Journal of Neuroradiology.

[17]  Carlos Miranda,et al.  CURATIVE ENDOVASCULAR RECONSTRUCTION OF CEREBRAL ANEURYSMS WITH THE PIPELINE EMBOLIZATION DEVICE: THE BUENOS AIRES EXPERIENCE , 2009, Neurosurgery.

[18]  J. Lamoureux,et al.  Long-Term Angiographic Recurrences After Selective Endovascular Treatment of Aneurysms With Detachable Coils , 2003, Stroke.

[19]  Boris Lubicz,et al.  Pipeline flow-diverter stent for endovascular treatment of intracranial aneurysms: preliminary experience in 20 patients with 27 aneurysms. , 2011, World neurosurgery.

[20]  C. Putman,et al.  Aneurysm Rupture Following Treatment with Flow-Diverting Stents: Computational Hemodynamics Analysis of Treatment , 2010, American Journal of Neuroradiology.

[21]  J. Pruvo,et al.  Flow-Diverter Stent for the Endovascular Treatment of Intracranial Aneurysms: A Prospective Study in 29 Patients With 34 Aneurysms , 2010, Stroke.

[22]  A. Molyneux,et al.  Barrow ruptured aneurysm trial. , 2013, Journal of neurosurgery.

[23]  P. Lylyk,et al.  Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms , 2009, Journal of NeuroInterventional Surgery.

[24]  G. Duckwiler,et al.  Challenges in the endovascular treatment of giant intracranial aneurysms. , 2008, Neurosurgery.

[25]  G. Rinkel,et al.  Late Reopening of Adequately Coiled Intracranial Aneurysms: Frequency and Risk Factors in 400 Patients With 440 Aneurysms , 2011, Stroke.

[26]  K. terBrugge,et al.  Clinical and angiographic long-term follow-up of completely coiled intracranial aneurysms using endovascular technique. , 2010, Journal of neurosurgery.

[27]  Baruch B. Lieber,et al.  Treatment of Rabbit Elastase-Induced Aneurysm Models by Flow Diverters: Development of Quantifiable Indexes of Device Performance Using Digital Subtraction Angiography , 2009, IEEE Transactions on Medical Imaging.

[28]  H. Woo,et al.  Very Late Thrombosis of a Pipeline Embolization Device Construct: Case Report , 2010, Neurosurgery.

[29]  S. Renowden,et al.  Intra-Aneurysmal Thrombosis as a Possible Cause of Delayed Aneurysm Rupture after Flow-Diversion Treatment , 2010, American Journal of Neuroradiology.

[30]  T. Krings,et al.  A Novel Grading Scale for the Angiographic Assessment of Intracranial Aneurysms Treated Using Flow Diverting Stents , 2010, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[31]  D F Kallmes,et al.  A Second-Generation, Endoluminal, Flow-Disrupting Device for Treatment of Saccular Aneurysms , 2009, American Journal of Neuroradiology.

[32]  C. Gandhi,et al.  The Pipeline Embolization Device for the Intracranial Treatment of Aneurysms Trial , 2012 .

[33]  Yuichi Murayama,et al.  Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. , 2003, Journal of neurosurgery.

[34]  Shandra Bipat,et al.  Coiling of Intracranial Aneurysms: A Systematic Review on Initial Occlusion and Reopening and Retreatment Rates , 2009, Stroke.

[35]  E. Vicaut,et al.  Endovascular treatment of basilar tip aneurysms with Guglielmi detachable coils: predictors of immediate and long-term results with multivariate analysis 6-year experience. , 2003, Radiology.

[36]  M. Sluzewski,et al.  Perforator Infarction after Placement of a Pipeline Flow-Diverting Stent for an Unruptured A1 Aneurysm , 2010, American Journal of Neuroradiology.

[37]  David F. Kallmes,et al.  A New Endoluminal, Flow-Disrupting Device for Treatment of Saccular Aneurysms , 2007, Stroke.

[38]  P. Summers,et al.  Retreatment of Ruptured Cerebral Aneurysms in Patients Randomized by Coiling or Clipping in the International Subarachnoid Aneurysm Trial (ISAT) , 2007, Stroke.