Pipeline embolization device for recurrence of previously treated aneurysms

Area of Science:

• Neurosurgery
• Endovascular Therapy
• Cerebrovascular Disease

Background:

• The Pipeline embolization device (PED) is approved for large, broad-necked internal carotid artery aneurysms.
• Recurrent aneurysms after initial treatment pose challenges, with controversial retreatment options.
• The role of PED in treating recurrent aneurysms is not well-defined.

Purpose of the Study:

• To assess the safety and efficacy of PED for treating recurrent aneurysms.
• To evaluate PED performance after prior endovascular coiling, flow diversion, or microsurgical clipping.

Main Methods:

• Retrospective review of 13 patients with recurrent aneurysms treated with secondary PED placement.
• Analysis of outcomes based on prior treatment modality: endovascular coiling (7), flow diversion (2), microsurgical clipping (4).
• Assessment of clinical outcomes (morbidity, mRS) and angiographic complete occlusion rates.

Main Results:

• Successful PED placement in all cases without periprocedural complications.
• High complete occlusion rates: 80% at 6 months and 100% at 12 months post-PED for coil recurrence.
• 100% occlusion at 6 and 12 months for clipping recurrence, with no adverse sequelae.

Conclusions:

• PED is a safe and effective retreatment option for recurrent aneurysms.
• High rates of complete aneurysm occlusion and minimal morbidity are achieved with PED after prior treatments.
• PED offers a viable solution for challenging recurrent aneurysm cases.