Pipeline embolization device in aneurysmal subarachnoid hemorrhage

Area of Science:

• Neuroendovascular interventions
• Cerebrovascular disease management
• Medical device technology

Background:

• Limited data exists on using flow-diverting stents (FDS) like the PED for ruptured intracranial aneurysms in acute or subacute subarachnoid hemorrhage (aSAH).
• Challenging aneurysm morphologies present significant treatment hurdles.

Purpose of the Study:

• To assess the feasibility of using the PED, a flow-diverting stent, for treating ruptured intracranial aneurysms with complex morphologies.
• To evaluate the safety and efficacy of PED in the acute/subacute aSAH setting.

Main Methods:

• Retrospective review of 20 patients treated with PED for aSAH across four institutions (June 2008 - January 2012).
• Case-by-case treatment decisions made by a multidisciplinary team under compassionate use.
• Collection and central collation of clinical and radiologic data.

Main Results:

• Twenty patients (median age 54.5 years) with various aneurysm types (blister, dissecting, saccular, giant) were treated.
• Median time to treatment was 4 days post-rupture; 15% procedure-related morbidity/mortality.
• At 6 and 12 months, occlusion rates were 75% and 94%, respectively; 81% achieved a good outcome (GOS 5).

Conclusions:

• The PED is a feasible treatment option for selected ruptured aneurysms in acute/subacute aSAH, especially blister aneurysms.
• Giant ruptured aneurysms remain challenging; cautious use of FDS is recommended for this subtype.
• The PED demonstrates potential for managing complex ruptured intracranial aneurysms.