Pipeline Embolization Device for Intracranial Aneurysm: A Systematic Review

• Published in: Clinical neuroradiology (Munich) Vol. 22; no. 4; pp. 295 - 303
• Main Authors: Leung, G. K. K., Tsang, A. C. O., Lui, W. M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-12-2012; Springer; Springer Nature B.V
• Subjects: Aneurysm, Ruptured - therapy; Aneurysms; Care and treatment; Embolization, Therapeutic - instrumentation; Equipment Design; Follow-Up Studies; Health aspects; Hemorrhage; Humans; Intracranial Aneurysm - therapy; Intracranial Embolism - diagnosis; Intracranial Embolism - mortality; Intracranial Embolism - therapy; Long-Term Care; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosurgery; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Review; Review Article; Stents; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - mortality; Subarachnoid Hemorrhage - therapy; Treatment Outcome; Flow diverter; Cerebral aneurysm; Endovascular treatment; Pipeline embolization device
• ISSN: 1869-1439; 1869-1447
• DOI: 10.1007/s00062-012-0178-6

Introduction
The pipeline embolization device (PED) is a new endovascular stent designed for the treatment of challenging intracranial aneurysms (IAs). Its use has been extended to nonruptured and ruptured IAs of a variety of configurations and etiologies in both the anterior and posterior circulations.
Methods
We conducted a systematic review of ten eligible reports on its clinical efficacy and safety.
Results
There were 414 patients with 448 IAs. The majority of the IAs were large (40.2 %), saccular or blister-like (78.3 %), and were located mostly in the anterior circulation (83.5 %). The regimens of antiplatelet therapy varied greatly between and within studies. The mean number of the PED used was 2.0 per IA. Deployment was successful in around 95 % of procedures. Aneurysm obliteration was achieved in 82.9 % of IAs at 6-month. The overall incidences of periprocedural intracranial vascular complication rate and mortality rate were 6.3 and 1.5 %, respectively.
Conclusion
The PED is a safe and effective treatment for nonruptured IAs. Its use in the context of acute subarachnoid hemorrhage (SAH) should be cautioned. Its main limitations include the need for prolonged antiplatelet therapy, as well as the potential risks of IA rupture and non-IA-related intracerebral hemorrhages (ICH). Future studies should aim at identifying factors that predispose to incomplete obliteration, delayed rupture, and thromboembolic complications.