• Nohra Chalouhi, Adam Polifka, Badih Daou, David Kung, Guilherme Barros, Stavropula Tjoumakaris, L Fernando Gonzalez, Robert M Starke, David Hasan, Brendan Judy, Robert H Rosenwasser, and Pascal Jabbour.
• *Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; ‡Department of Neurosurgery, University of Iowa, Iowa City, Iowa.
• Neurosurgery. 2015 Dec 1; 77 (6): 875-9; discussion 879.

BackgroundThe Pipeline Embolization Device is a widely utilized flow diverter in the treatment of intracranial aneurysms.ObjectiveTo assess the incidence, clinical significance, predictors, and outcomes of in-Pipeline stenosis (IPS).MethodsAngiographic studies in 139 patients treated between 2011 and 2013 were independently reviewed by 2 authors for the presence of IPS. Multivariable logistic regression analysis was conducted to determine predictors of IPS.ResultsA total of 21 (15.8%) patients demonstrated some degree of IPS during the follow-up period at a mean time point of 6.7 months (range, 3-24 months). The stenosis was mild (<50%) in 11 patients, moderate (50%-75%) in 5, and severe (>75%) in 6. None were symptomatic or required further intervention. Sixteen of these 22 patients (73%) had IPS detected within 6 months. IPS was noted in 7.6% (1/13) of patients with posterior circulation aneurysms vs 16.7% (21/126) of those with anterior circulation aneurysms (P = .03). The rate of IPS was 60% (3/5) in patients who did not receive aspirin vs only 14.2% (19/134) in those who received aspirin (P = .02). In multivariable analysis, no aspirin therapy (odds ratio, 10.0; 95% confidence interval, 1.4-67.7; P = .02) and internal carotid artery aneurysm location (odds ratio, 3.1; 95% confidence interval, 1.1-8.8; P = .03) were strong independent predictors of IPS.ConclusionIPS is a common, early, and mostly benign complication. Patients with internal carotid artery aneurysms are more likely to develop IPS. Aspirin plays a key role in preventing IPS. The results of this study further support the safety of flow diverters.AbbreviationsIPS, in-Pipeline stenosisPED, Pipeline Embolization Device.

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