Safety and efficacy of the Pipeline Embolization Device in 100 small intracranial aneurysms

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Flow diverters are increasingly used for treatment of intracranial aneurysms. In most series, the Pipeline Embolization Device (PED) was used for the treatment of large, giant, complex, and fusiform aneurysms. Little is known about the use of the PED in small aneurysms. The purpose of this study was to assess the safety and efficacy of the PED in small aneurysms (≤ 7 mm).


A total of 100 consecutive patients were treated with the PED at the authors' institution between May 2011 and September 2013. Data on procedural safety and efficacy were retrospectively collected.


The mean aneurysm size was 5.2 ± 1.5 mm. Seven patients (7%) had sustained a subarachnoid hemorrhage. All except 5 aneurysms (95%) arose from the anterior circulation. The number of PEDs used was 1.2 per aneurysm. Symptomatic procedure-related complications occurred in 3 patients (3%): 1 distal parenchymal hemorrhage that was managed conservatively and 2 ischemic events. At the latest follow-up (mean 6.3 months), 54 (72%) aneurysms were completely occluded (100%), 10 (13%) were nearly completely occluded (≥ 90%), and 11 (15%) were incompletely occluded (< 90%). Six aneurysms (8%) required further treatment. Increasing aneurysm size (OR 3.8, 95% CI 0.99–14; p = 0.05) predicted retreatment. All patients achieved a favorable outcome (modified Rankin Scale Score 0–2) at follow-up.


In this study, treatment of small aneurysms with the PED was associated with low complication rates and high aneurysm occlusion rates. These findings suggest that the PED is a safe and effective alternative to conventional endovascular techniques for small aneurysms. Randomized trials with long-term follow-up are necessary to determine the optimal treatment that leads to the highest rate of obliteration and the best clinical outcomes.

ABBREVIATIONSICA = internal carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; PED = Pipeline Embolization Device; SAH = subarachnoid hemorrhage.

Article Information

Correspondence Pascal M. Jabbour, Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut St., 3rd Fl., Philadelphia, PA 19107. email:

INCLUDE WHEN CITING Published online January 30, 2015; DOI: 10.3171/2014.12.JNS14411.

DISCLOSURE Drs. Jabbour and Tjoumakaris are consultants for Covidien, and Dr. Tjoumakaris is also a consultant for Stryker.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Angiogram showing a small 5-mm aneurysm arising from the left ICA (A). A PED was inserted in the ICA (B), with complete occlusion at follow-up (C).

  • View in gallery

    Angiogram showing a 5-mm fusiform aneurysm arising from the M3 segment of the middle cerebral artery (MCA) (A and B). A PED was successfully placed across the aneurysm in the MCA (C). Follow-up angiogram showing 100% aneurysm occlusion, with remodeling of the parent vessel (D).


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