• Lukas Goertz, Muriel Pflaeging, Christian Gronemann, David Zopfs, Jonathan Kottlors, Marc Schlamann, Franziska Dorn, Thomas Liebig, and Christoph Kabbasch.
• Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany. Electronic address: lukas.goertz@uk-koeln.de.
• World Neurosurg. 2024 Mar 1; 183: e210e217e210-e217.

ObjectiveThe Pipeline Vantage Embolization Device is a fourth-generation flow diverter with an antithrombotic coating and a reduced profile compared to previous Pipeline versions. The objective of this study was to evaluate the procedural feasibility, safety, and efficacy of this device.MethodsThe Pipe-VADER study was designed as a retrospective, observational study of consecutive patients treated with the Vantage at 3 neurovascular centers. Patient and aneurysm characteristics, procedural parameters, early complications, and extent of postinterventional contrast retention were analyzed on an intention-to-treat basis.ResultsTwenty-eight patients with 31 aneurysms (median size: 5.0 mm, posterior circulation: 4 [12.9%], ruptured: 5 [16.1%]) were included. The technical success rate was 100%, with multiple stents used in 4/30 (13.3%) procedures. Of the 30 procedures, adjunctive coiling was performed in 3 (10.0%) and balloon angioplasty in 2 (6.7%). Median procedure time was 62 minutes. Procedural ischemic stroke occured in 4 (13.3%) cases, whereof 2 were major strokes (6.6%). There were no hemorrhagic complications. Initial contrast retention was observed in 29/31 (93.5%) aneurysms. All 27 overstented side vessels were patent at the end of the procedure. Short-term follow-up (median: 5 months) showed complete and favorable occlusion rates of 70% (14/20) and 80% (16/20), respectively.ConclusionsThe new Pipeline Vantage appears to be safe and feasible for the treatment of intracranial aneurysms and warrants further evaluation.Copyright © 2023 Elsevier Inc. All rights reserved.

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