• Allan R Martin, Juan Pablo Cruz, Charles C Matouk, Julian Spears, and Thomas R Marotta.
• Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
• Neurosurgery. 2012 Mar 1; 70 (1 Suppl Operative): 21-8; discussion 28.

BackgroundThe 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).ObjectiveTo demonstrate the feasibility of utilizing the PED as a primary treatment for ruptured aneurysms with challenging morphologies.MethodsThree 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.ResultsPEDs 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.ConclusionEndovascular 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.

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