• Ning Lin, Adam M Brouillard, Kiffon M Keigher, Demetrius K Lopes, Mandy J Binning, Kenneth M Liebman, Erol Veznedaroglu, Jordan A Magarik, J Mocco, Edward A Duckworth, Adam S Arthur, Andrew J Ringer, Kenneth V Snyder, Elad I Levy, and Adnan H Siddiqui.
• Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
• J Neurointerv Surg. 2015 Nov 1; 7 (11): 808-15.

ObjectiveUtilization of the Pipeline embolization device (PED) in complex ruptured aneurysms has not been well studied. We evaluated the safety and effectiveness data from five participating US centers.MethodsRecords of patients with ruptured cerebral aneurysms who underwent PED treatment between 2011 and 2013 were retrospectively reviewed.Results26 patients with ruptured aneurysms underwent PED treatment (mean age 51.4 ± 13.2 years;16 women). At presentation, 8 patients (30.8%) had a Hunt-Hess grade of IV or above; 11 required extraventricular drain placement. Aneurysm morphologies were: 8 dissecting, 8 blister-like, 6 fusiform, and 4 saccular. There were 22 anterior circulation and 4 posterior circulation aneurysms. PED deployment was successful in all patients, with adjunctive coiling utilized in 12. Periprocedural complications occurred in 5 (19.2%), including 3 inhospital deaths. 23 patients (88.5%) had postoperative angiography at a mean of 5.9 months: 18 aneurysms (78.3%) were completely occluded, 3 (13.0%) had residual neck filling, and 2 (8.7%) had residual dome filling. All blister-type aneurysms were completely occluded at follow-up. Clinical follow-up was available for an average of 10.1 months (range 2-21 months), with one asymptomatic in-stent stenosis and one asymptomatic thromboembolic stroke noted. Good outcome (modified Rankin Scale (mRS) score of 0-2) was achieved in 20 patients (76.9%), fair (mRS 3-4) in 3 (11.5%), and 3 died (11.5%).ConclusionsThe PED can be utilized for ruptured aneurysms and is a good option for blister-type aneurysms. However, due to periprocedural complications, it should be reserved for lesions that are difficult to treat by conventional clipping or coiling.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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