Short-term effect of Pipeline Flex embolization device in the treatment of complex intracranial aneurysms

Objective To investigate the short-term efficacy of Pipeline embolization device (PED) in the treatment of complex intracranial aneurysms. Methods A retrospective analysis of clinical data was conducted on 37 patients who underwent endovascular treatment with PEDs at Neurosurgery Department of Nanfang Hospital, Southern Medical University from January 2018 to March 2019. There were 45 aneurysms in 37 patients (including 7 cases with tandem wide-necked small aneurysms) which were distributed in internal carotid artery (38 cases), vertebral artery (3 cases), middle cerebral artery (3 cases) and anterior cerebral artery (1 case). The maximum diameter of aneurysm ranged from 2.0 to 34.8 mm. In this series, the diameters in 22 aneurysms were no longer than 10 mm and those in the other 23 aneurysms were larger than 10 mm. The modified Rankin scale (mRS) was used to evaluate the prognosis. Results A total of 37 PEDs were placed for 37 patients with 45 intracranial aneurysms in this study (Pipeline Flex stent-assisted embolization performed in 13 cases and stent-only treatment in 24). Retentions of contrast agent in the aneurysm cavity were detected by immediate postoperative radiography for 37 aneurysms, which showed that the aneurysm-bearing arteries were smooth and had no stenosis. All PEDs were well attached according to DynaCT fusion 3D reconstruction. Perioperative complications occurred in 11 patients, among whom 2 died. There were 35 patients followed-up for 1 month after discharge and no neurological symptoms were observed. Conclusions The treatment of complex intracranial aneurysms with PEDs is relatively safe and effective. Further optimization may still be needed for the perioperative anti-platelet aggregation regimen. Key words: Intracranial aneurysm; Endovascular procedures; Flow diverter; Treatment outcome