Utilization of pipeline embolization device for treatment of ruptured complex intracranial aneurysms

Use of the Pipeline embolization device (PED) for treatment of ruptured complex intracranial aneurysms (IAs) remains controversial due to higher thromboembolic and hemorrhagic complications compared to balloon-assisted coiling. We present our experience using the PED for ruptured complex IAs and focus on the safety, effectiveness, and follow-up results.

Consecutive 46 patients with ruptured complex IAs who had undergone PED deployment from January 2019 to December 2023 at our neurosurgical center were retrospectively enrolled. Patient demographics, aneurysm characteristics, procedural complications, clinical and angiographic follow-up outcomes were reviewed.

A total of 46 patients were analyzed with a mean age of 55.8 ± 13.4 years, including 30(65.2%) females. WFNS grades were I in 27 patients (58.7%), II in 10 (21.7%), III in 5 (10.9%), IV in 2 (4.3%), and V in 2 (4.3%). The ruptured aneurysms included 12 (26.1%) saccular, 23 (50.0%) blister-like, 10 (21.7%) dissecting, and 1(2.2%) fusiform. The average size of IAs was 4.3 ± 2.9 mm. PED deployment was technically successful in all patients and adjunctive coiling was performed in 44(95.7%) patients. The rate of procedural-related complications was 13.0% (6/46), including 2 hemorrhagic and 4 ischemic complications. One patient died of rerupture of aneurysm (1/46, 2.2%), and 95.3% of patients (41/43) had favorable outcomes at the 90-day follow-up. Among 40 available cases, complete aneurysm occlusion was obtained in 38 cases (95.0%, 38/40) at a mean follow-up of 7.5 months.

Treatment of ruptured complex IAs with the PED was associated with acceptable complication rates, high complete occlusion rates, and good clinical outcomes. Therefore, PED may be a safe and effective option for ruptured IAs that were difficult to treat by conventional endovascular and surgical approaches. However, larger and comparative studies with long-term follow-up are needed to confirm this result.