title: New Pipeline Flex device: initial experience and technical nuances.
abstract: BACKGROUND
  Flow diverter stents (FDS) have been described as a breakthrough in the treatment of intracranial aneurysms. Of the various flow diverter models, the Pipeline device has been the main approved and used device, with established and good long-term results.
  
  
  OBJECTIVE
  To present the first series of patients treated with its new version, the Pipeline Flex device. This has kept the same device design and configuration but redesigned and completely modified the delivery system.
  
  
  METHODS
  In this technical report, we include 10 consecutive patients harboring 12 saccular aneurysms of the anterior circulation. We report the main changes on the system, immediate results, and technical nuances with illustrative cases.
  
  
  RESULTS
  We implanted 12 devices, including 11 Pipeline Flex and one Pipeline device. We used the old version in one case that required a second layer with a short length not available in the Pipeline Flex size range. All attempts at treatment were successful and no device was discharged or removed. Recovery was required or used in half of the cases with good or excellent performance, except in one case that presented with multiple proximal loops and tight curves. We had two transitory events without ischemic lesions on MRI that recovered 1 and 4 h after all patients were discharged home asymptomatic.
  
  
  CONCLUSIONS
  Pipeline Flex represents a major advance in FDS technology. The redesigned system has significantly improved the deployment of the Pipeline stent, by enabling the operator to resheath the device. It has the potential to continue revolutionizing the endovascular approach for intracranial aneurysms.
authors.affiliation: Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Vitor Mendes
authors.initials: VM
authors.lastname: Pereira
authors.affiliation: Division of Neurosurgery, Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Kelly
authors.affiliation: Department of Interventional Neuroradiology, Oviedo, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Vega
authors.affiliation: Department of Interventional Neuroradiology, Oviedo, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Murias
authors.affiliation: Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Hasan
authors.initials: H
authors.lastname: Yilmaz
authors.affiliation: Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Gorislav
authors.initials: G
authors.lastname: Erceg
authors.affiliation: Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Alain
authors.initials: A
authors.lastname: Pellaton
authors.affiliation: Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Karl-olof
authors.initials: KO
authors.lastname: Lovblad
authors.affiliation: Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Timo
authors.initials: T
authors.lastname: Krings
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015607:Stents
keywords: Aneurysm; Flow Diverter; Stent; Technique; Technology