title: The pipeline flow-diverting stent for exclusion of ruptured intracranial aneurysms with difficult morphologies.
abstract: BACKGROUND
  The Pipeline Embolization Device (PED) is a flow-diverting stent that may represent a new therapeutic tool for difficult-to-treat intracranial aneurysms, including those that present with subarachnoid hemorrhage (SAH).
  
  
  OBJECTIVE
  To demonstrate the feasibility of utilizing the PED as a primary treatment for ruptured aneurysms with challenging morphologies.
  
  
  METHODS
  Three patients with ruptured intracranial aneurysms presented with SAH. Three distinct and difficult-to-treat aneurysm morphologies were encountered: (1) a small basilar trunk pseudoaneurysm, (2) a carotid artery blister aneurysm, and (3) an A1/A2 junction-dissecting-type aneurysm. All were treated with deployment of one or more PEDs across the aneurysm.
  
  
  RESULTS
  PEDs were successfully deployed in all 3 cases. Two patients were treated with 2 overlapping PEDs, and the third patient was treated with a single device. Aneurysm obliteration was achieved in all 3 cases with no early rehemorrhage or other clinically adverse event.
  
  
  CONCLUSIONS
  Endovascular treatment with the pipeline flow-diverting stent may be a viable treatment option for otherwise difficult-to-treat aneurysm morphologies in the context of acute SAH.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Allan R
authors.initials: AR
authors.lastname: Martin
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Cruz
authors.forename: Charles C
authors.initials: CC
authors.lastname: Matouk
authors.forename: Julian
authors.initials: J
authors.lastname: Spears
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Marotta
mesh_terms: D000328:Adult; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012421:Rupture / Q000150:complications / Q000473:pathology / Q000601:surgery*; D015607:Stents / Q000592:standards*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*