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Use of pipeline flow diverting stents for wide neck intracranial aneurysms: A retrospective institutional review

Background: Intracranial aneurysms (ICA) if inadequately treated may result in serious morbidity and mortality. Wide-neck; large/giant, fusiform, and dissecting aneurysms are not well treated using the conventional coil embolization technique. Recent advance in endovascular treatment and technology has introduced flow diverter devices including pipeline embolization devices (PED) and Silk stents that have been shown to be more effective in treating these more complicated aneurysms. Flow Diverter devices offer a more physiologic approach to ICA treatment. Methods: We conducted a retrospective chart review of 23 adult patients who underwent aneurysm treatment utilizing the pipeline stent at Duke University Medical Center from July 2011 to March 2013. Results: Majority of patients (19, 82.7%) showed angiographic evidence of complete obliteration of aneurysm at 6 months follow-up, with sustained clinical improvement on modified Rankin scale score. All of the patients tolerated the procedure well with no intra-operative hemorrhage or intra-operative thromboembolic complications. Conclusions: Our experience shows that use of PED offers a safe and effective strategy for treatment of complex ICA. Larger prospective studies are needed to confirm these observations.