Treatment of Intracranial Aneurysms With Pipeline Embolization Device: Newer Applications and Technical Advances
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Pipeline embolization device (PED) is a flow diverter used in the endovascular treatment of intracranial aneurysms, particularly those with unfavorable configurations. It works by causing progressive flow redirection leading to thrombosis within the aneurysm. PED was initially approved for adults with large or giant wide-necked (≥4 mm or no discernible neck) aneurysms of the internal carotid artery (ICA) from the petrous to the superior hypophyseal segments. Studies have shown a superior aneurysm occlusion rate of 85 % at 6 months for the PED and mortality ranging from 2.6 to 4 %. There appears to be a knowledge gap in terms of the duration of dual antiplatelet therapy and efficacy of assessing platelet inhibition. However, increasing operator experience and favorable longer-term outcome data have led to the exploration of PED for a wide array of off-label uses. Given the paucity of good-quality studies comparing PED with other endovascular/surgical treatment options, several multicenter randomized trials are currently underway to answer these important questions.
KeywordsPipeline embolization device Flow diverter Intracranial aneurysm Subarachnoid hemorrhage
A special thank you to Dr. Myrna Rosenfeld for taking the time to review this manuscript.
Compliance with Ethical Standards
Conflict of Interest
Santosh B. Murthy, Jharna Shah, Halinder S. Mangat, and Philip Stieg declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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