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The Pipeline Flow-Diverting Stent for Exclusion of Ruptured Intracranial Aneurysms With Difficult Morphologies

Martin, Allan R. MD*; Cruz, Juan Pablo MD‡,§; Matouk, Charles C. MD§; Spears, Julian MD, SM‡,§,‖; Marotta, Thomas R. MD‡,§

doi: 10.1227/NEU.0b013e3182315ee3
Instrumentation and Technique: Editor's Choice
Editor's Choice

BACKGROUND: The Pipeline Embolization Device (PED) is a flow-diverting stent that may represent a new therapeutic tool for difficult-to-treat intracranial aneurysms, including those that present with subarachnoid hemorrhage (SAH).

OBJECTIVE: To demonstrate the feasibility of utilizing the PED as a primary treatment for ruptured aneurysms with challenging morphologies.

METHODS: Three patients with ruptured intracranial aneurysms presented with SAH. Three distinct and difficult-to-treat aneurysm morphologies were encountered: (1) a small basilar trunk pseudoaneurysm, (2) a carotid artery blister aneurysm, and (3) an A1/A2 junction-dissecting-type aneurysm. All were treated with deployment of one or more PEDs across the aneurysm.

RESULTS: PEDs were successfully deployed in all 3 cases. Two patients were treated with 2 overlapping PEDs, and the third patient was treated with a single device. Aneurysm obliteration was achieved in all 3 cases with no early rehemorrhage or other clinically adverse event.

CONCLUSION: Endovascular treatment with the pipeline flow-diverting stent may be a viable treatment option for otherwise difficult-to-treat aneurysm morphologies in the context of acute SAH.

*Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Department of Radiology, St. Michael's Hospital, Toronto, Ontario, Canada

§Department of Medical Imaging, University of Toronto, Ontario, Ontario, Canada

Division of Neurosurgery, St. Michael's Hospital, Ontario, Canada

Correspondence: Thomas R. Marotta, MD, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada M5B1W8. E-mail:

Received November 17, 2010

Accepted June 8, 2011

Copyright © by the Congress of Neurological Surgeons