Related Experiment Video
Updated: Jan 17, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Single-Session and Staged Combination of Pipeline Embolization Device and Woven EndoBridge Device for Complex
Arevik Abramyan1, Sudipta Roychowdhury2, Srihari Sundararajan2
1Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick , New Jersey , USA.
Background And Objectives:
The Pipeline Embolization Device (PED) and Woven EndoBridge (WEB) device are effective treatments for intracranial aneurysms, but certain complex lesions may benefit from their combination. This study evaluates outcomes and highlights technical nuances of single-session and staged PED + WEB treatments compared with PED or WEB alone.
Methods:
A retrospective review was conducted of patients treated from 2021 to 2024 at our institution, divided into PED-only (n = 84), WEB-only (n = 35), and combined PED + WEB groups (n = 14). Combined treatments were further divided into single-session (simultaneous PED and WEB placement) and staged treatments. We analyzed demographics, aneurysm features, procedural details, angiographic outcomes (Raymond-Roy grading), and functional outcomes (modified Rankin Scale).
Results:
At 1-month follow-up, single-session PED + WEB treatments demonstrated significantly better aneurysm occlusion compared with PED-only cases ( P < .05). Combined treatments predominantly targeted complex or acutely ruptured aneurysms. At 2 years, combined PED + WEB treatments achieved 100% complete aneurysm occlusion, significantly exceeding WEB-only cases ( P = .014). Functional outcomes (modified Rankin Scale) significantly favored combined treatment compared with WEB-only therapy ( P = .013). No procedure-related complications or deaths occurred in combined groups. Mortality rates were higher in the WEB-only group (11.43%) compared with PED-only (2.38%), with no deaths in combined-treatment groups.
Conclusion:
Combined PED and WEB treatment represents a feasible and highly effective approach for selected complex aneurysms. It offers superior angiographic occlusion rates and improved clinical outcomes compared with single-device treatments, particularly for complex aneurysms, with comparable safety profiles.
