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Incidence and risk factors for delayed structural changes in Pipeline Embolization Devices.
Clint Badger1, Souvik Singha2, Huanwen Chen2
1Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA badger.clint@gmail.com.
Journal of Neurointerventional Surgery
|April 9, 2026
Summary
Delayed braid deformation (DBD) of Pipeline Embolization Devices (PEDs) for intracranial aneurysms is common but usually mild. Younger age and device oversizing are key risk factors for this flow diverter complication.
Area of Science:
- Neuroendovascular therapy
- Medical device engineering
Background:
- Flow-diverting stents, like the Pipeline Embolization Device (PED), are crucial for treating intracranial aneurysms.
- Delayed braid deformation (DBD) can compromise vessel integrity and increase stroke risk.
- Limited data exists on the incidence, progression, and predictors of DBD.
Purpose of the Study:
- To determine the incidence, evolution, and predictors of delayed braid deformation (DBD) in Pipeline Embolization Devices (PEDs).
- To identify patient and procedural factors associated with DBD after aneurysm treatment.
Main Methods:
- Retrospective analysis of 566 Pipeline Embolization Device (PED) treatments for intracranial aneurysms.
- Inclusion of patients with follow-up imaging; exclusion of those with other flow diverters.
- Collection of demographic, aneurysm, and procedural data; multivariable logistic regression for predictor identification.
Main Results:
- Delayed braid deformation (DBD) occurred in 10.4% of PED treatments.
- Younger age and device oversizing (≥1 mm) were independent predictors of DBD.
- Most DBD cases were mild and self-limited, with spontaneous improvement in over 50% of untreated cases.
Conclusions:
- Delayed braid deformation (DBD) of the Pipeline Embolization Device (PED) is a frequent complication after aneurysm treatment.
- Younger patient age and device oversizing are significant risk factors for DBD.
- DBD is typically mild and often resolves spontaneously, but severe cases may require intervention.
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