• Christoph J Griessenauer, Christopher S Ogilvy, Paul M Foreman, Michelle H Chua, Mark R Harrigan, Lucy He, Matthew R Fusco, J D Mocco, Christopher J Stapleton, Aman B Patel, Ashish Sonig, Adnan H Siddiqui, and Ajith J Thomas.
• Neurosurgical Service, Beth Israel Dea-coness Medical Center, Harvard Medic-al School, Boston, Massachusetts.
• Neurosurgery. 2017 Apr 1; 80 (4): 579-587.

BackgroundTo date, the use of the flow-diverting Pipeline Embolization Device (PED) for small intracranial aneurysms (≤ 7 mm) has been reported only in single-center series.ObjectiveTo evaluate the safety and efficacy of the PED in a multicenter cohort.MethodsFive major academic institutions in the United States provided data on patient demographics, aneurysm features, and treatment characteristics of consecutive patients with aneurysms ≤ 7 mm treated with a PED between 2009 and 2015. Radiographic outcome was assessed with digital subtraction angiography. Clinical outcome was measured with the modified Rankin Scale.ResultsThe cumulative number of aneurysms ≤ 7 mm treated with PED at the 5 institutions was 149 in 117 patients (age, 54 years [range, 29-87 years]; male to female, 1-5.9). Aneurysms were most commonly located in the paraophthalmic segment (67.1%) of the internal carotid artery. Radiographic outcome at last follow-up was available for 123 aneurysms (82.6%), with a complete occlusion rate of 87%. Thromboembolic and symptomatic procedural complications occurred in 8.7% and 6% of the aneurysms treated, respectively. There was 1 mortality (0.9%) unrelated to the PED procedure. Multivariable logistic regression identified size < 4 mm, balloon angioplasty to open the device, and simultaneous treatment of multiple aneurysms as predictors of procedural complications. Good clinical outcome was achieved in 96% of electively treated patients.ConclusionIn the largest series on PED for small aneurysms to date, data suggest that treatment with the flow-diverting PED is safe and efficacious, with complication rates comparable to those for traditional endovascular techniques.Copyright © 2016 by the Congress of Neurological Surgeons

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