• Peter Kan, Adnan H Siddiqui, Erol Veznedaroglu, Kenneth M Liebman, Mandy J Binning, Travis M Dumont, Christopher S Ogilvy, John R Gaughen, J Mocco, Gregory J Velat, Andrew J Ringer, Babu G Welch, Michael B Horowitz, Kenneth V Snyder, L Nelson Hopkins, and Elad I Levy.
• Department of Neurosurgery and Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York 14203, USA.
• Neurosurgery. 2012 Dec 1;71(6):1080-7; discussion 1087-8.

BackgroundThe pipeline embolization device (PED) is the latest technology available for intracranial aneurysm treatment.ObjectiveTo report early postmarket results with the PED.MethodsThis study was a prospective registry of patients treated with PEDs at 7 American neurosurgical centers subsequent to Food and Drug Administration approval of this device. Data collected included clinical presentation, aneurysm characteristics, treatment details, and periprocedural events. Follow-up data included degree of aneurysm occlusion and delayed (> 30 days after the procedure) complications.ResultsSixty-two PED procedures were performed to treat 58 aneurysms in 56 patients. Thirty-seven of the aneurysms (64%) treated were located from the cavernous to the superior hypophyseal artery segment of the internal carotid artery; 22% were distal to that segment, and 14% were in the vertebrobasilar system. A total of 123 PEDs were deployed with an average of 2 implanted per aneurysm treated. Six devices were incompletely deployed; in these cases, rescue balloon angioplasty was required. Six periprocedural (during the procedure/within 30 days after the procedure) thromboembolic events occurred, of which 5 were in patients with vertebrobasilar aneurysms. There were 4 fatal postprocedural hemorrhages (from 2 giant basilar trunk and 2 large ophthalmic artery aneurysms). The major complication rate (permanent disability/death resulting from perioperative/delayed complication) was 8.5%. Among 19 patients with 3-month follow-up angiography, 68% (13 patients) had complete aneurysm occlusion. Two patients presented with delayed flow-limiting in-stent stenosis that was successfully treated with angioplasty.ConclusionUnlike conventional coil embolization, aneurysm occlusion with PED is not immediate. Early complications include both thromboembolic and hemorrhagic events and appear to be significantly more frequent in association with treatment of vertebrobasilar aneurysms.

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