The Pipeline embolization device for treatment of intracranial aneurysms

Flow diversion is a new endovascular technique developed for treatment of intracranial aneurysms. It is based on stent-induced modification of blood flow within and around an aneurysm inflow zone, leading to gradual intra-aneurysmal thrombosis and subsequent atrophy, while preserving flow into the parent vessel and perforating branches. Flow-diversion technique is well-suited for the treatment of large, giant, wide-necked, and fusiform intracranial aneurysms because it does not rely on endosaccular packing with coils but rather on the strategy of placing a stent across the aneurysm "neck" or across the diseased segment of a vessel in case of a fusiform aneurysm. Over time, neointimal endothelium covers the flow diverter such that it becomes incorporated into the parent vessel wall and occludes the aneurysm from the circulation, effectively repairing the diseased parent vessel segment. This report describes in detail the Pipeline embolization device (ev3-Covidien, Irvine, California, USA), its mechanism of action and deployment technique, and reviews the pertinent literature regarding safety, efficacy and potential risks and complications associated with the use of this flow diverter.