title: First Indian single center experience with pipeline embolization device for complex intracranial aneurysms.
abstract: BACKGROUND
  Flow diversion is a novel method of therapy wherein an endoluminal sleeve, the flow diverter stent is placed across the neck of complex aneurysms to curatively reconstruct abnormal vasculature. We present the first Indian single center experience with the pipeline embolization device (PED) and 6 months follow-up results of 5 patients.
  
  
  METHODS
  Five complex or recurrent intracranial aneurysms in five patients were treated with PED. The patients were followed-up with magnetic resonance angiography (MRA) after 4 weeks and conventional angiography after 6 months. Feasibility, complications, clinical outcome, early 1-month MRA and 6 months conventional angiographic follow-up results were analyzed.
  
  
  RESULTS
  Of the five aneurysms treated, four were in the anterior circulation and one in the posterior circulation. All five patients were treated with a single PED in each, and additionally coils were used in one patient. At 1-month MRA follow-up, complete occlusion was seen in 2 (40%) of the five cases. Post 6 months conventional angiography showed complete occlusion of the aneurysm sac in all five cases (100%). Side branch ostia were covered in three patients, all of which were patent (100%). There was no incidence of major neurological morbidity or mortality. One patient (20%) who had basilar top aneurysm experienced minor neurological disability after 5 days which partially improved.
  
  
  CONCLUSIONS
  Pipeline embolization device for complex and recurrent aneurysms is technically feasible, safe, offers low complication rate, and definitive vascular reconstruction. PED can be used without fear of occlusion of covered eloquent side branches and perforators.
authors.affiliation: Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India.
authors.forename: Mathew P
authors.initials: MP
authors.lastname: Cherian
authors.forename: Manish Kumar
authors.initials: MK
authors.lastname: Yadav
authors.forename: Pankaj
authors.initials: P
authors.lastname: Mehta
authors.forename: K
authors.initials: K
authors.lastname: Vijayan
authors.forename: V
authors.initials: V
authors.lastname: Arulselvan
authors.forename: Suresh
authors.initials: S
authors.lastname: Jayabalan
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D007194:India; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome