title: Use of pipeline flow diverting stents for wide neck intracranial aneurysms: A retrospective institutional review.
abstract: BACKGROUND
  Intracranial aneurysms (ICA) if inadequately treated may result in serious morbidity and mortality. Wide-neck; large/giant, fusiform, and dissecting aneurysms are not well treated using the conventional coil embolization technique. Recent advance in endovascular treatment and technology has introduced flow diverter devices including pipeline embolization devices (PED) and Silk stents that have been shown to be more effective in treating these more complicated aneurysms. Flow Diverter devices offer a more physiologic approach to ICA treatment.
  
  
  METHODS
  We conducted a retrospective chart review of 23 adult patients who underwent aneurysm treatment utilizing the pipeline stent at Duke University Medical Center from July 2011 to March 2013.
  
  
  RESULTS
  Majority of patients (19, 82.7%) showed angiographic evidence of complete obliteration of aneurysm at 6 months follow-up, with sustained clinical improvement on modified Rankin scale score. All of the patients tolerated the procedure well with no intra-operative hemorrhage or intra-operative thromboembolic complications.
  
  
  CONCLUSIONS
  Our experience shows that use of PED offers a safe and effective strategy for treatment of complex ICA. Larger prospective studies are needed to confirm these observations.
authors.affiliation: Department of Neurological Surgery and Radiology, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Neurology, Division of Neurocritical Care, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Sankalp
authors.initials: S
authors.lastname: Gokhale
authors.affiliation: Department of Radiology, Duke University Medical Center, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Jagan
authors.initials: J
authors.lastname: Gupta
authors.affiliation: Department of Radiology, Duke University Medical Center, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Roman
authors.initials: R
authors.lastname: Raju
authors.affiliation: Department of Neurological Surgery and Radiology, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Shahid
authors.initials: S
authors.lastname: Nimjee
authors.affiliation: Department of Radiology, Duke University Medical Center, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Tony
authors.initials: T
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA.
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Britz
keywords: Flow diverter; intracranial aneurysm; pipeline device