• Nimer Adeeb, Christoph J Griessenauer, Hussain Shallwani, Hakeem Shakir, Paul M Foreman, Justin M Moore, Adam A Dmytriw, Raghav Gupta, Adnan H Siddiqui, Elad I Levy, Kenneth Snyder, Mark R Harrigan, Christopher S Ogilvy, and Ajith J Thomas.
• Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
• World Neurosurg. 2017 Sep 1; 105: 232-237.

IntroductionTreatment of large (≥20 mm) and giant (≥25 mm) intracranial aneurysms is challenging and can be associated with a high rate of morbidity and mortality. The Pipeline Embolization Device (PED) has been used effectively for the treatment of intracranial aneurysms achieving a high rate of complete occlusion. However, its safety and efficacy in treatment of large and giant aneurysms has not been evaluated fully.MethodsA retrospective analysis of consecutive aneurysms treated with PED between 2009 and 2016 at 3 academic institutions within the United States was performed. Large (≥20 mm) and giant aneurysms (≥25 mm) were selected for evaluation of occlusion and complication rates following treatment with PED.ResultsA total of 50 large and giant aneurysms were individually treated using PED. Aneurysms were fusiform (74%) or saccular (26%) in morphology. PED alone was used for treating 78% of the aneurysms, whereas PED with adjunctive coiling was used for treating 22%. The median length of angiographic follow-up was 13 months (mean follow up 20.4 months). At last follow-up, complete or near-complete occlusion (90-100%) was achieved in 76.9% of aneurysms. Symptomatic thromboembolic complications were encountered in 12% of procedures and symptomatic hemorrhagic complications in 8%.ConclusionsThe use of PED for the treatment of large and giant intracranial aneurysms is associated with good occlusion rates, but also a greater complication rate compared to aneurysms of smaller size. There was no significant difference in occlusion rate based on aneurysm shape or size, number of PEDs placed, or adjunctive coiling.Copyright © 2017 Elsevier Inc. All rights reserved.

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