title: Treatment of Intracranial Aneurysms With Pipeline Embolization Device: Newer Applications and Technical Advances.
abstract: Pipeline embolization device (PED) is a flow diverter used in the endovascular treatment of intracranial aneurysms, particularly those with unfavorable configurations. It works by causing progressive flow redirection leading to thrombosis within the aneurysm. PED was initially approved for adults with large or giant wide-necked (≥4 mm or no discernible neck) aneurysms of the internal carotid artery (ICA) from the petrous to the superior hypophyseal segments. Studies have shown a superior aneurysm occlusion rate of 85 % at 6 months for the PED and mortality ranging from 2.6 to 4 %. There appears to be a knowledge gap in terms of the duration of dual antiplatelet therapy and efficacy of assessing platelet inhibition. However, increasing operator experience and favorable longer-term outcome data have led to the exploration of PED for a wide array of off-label uses. Given the paucity of good-quality studies comparing PED with other endovascular/surgical treatment options, several multicenter randomized trials are currently underway to answer these important questions.
authors.affiliation: Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA. sam9200@med.cornell.edu.|Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA. sam9200@med.cornell.edu.
authors.forename: Santosh B
authors.initials: SB
authors.lastname: Murthy
authors.affiliation: Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jharna
authors.initials: J
authors.lastname: Shah
authors.affiliation: Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA.|Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Halinder S
authors.initials: HS
authors.lastname: Mangat
authors.affiliation: Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Stieg
keywords: Flow diverter; Intracranial aneurysm; Pipeline embolization device; Subarachnoid hemorrhage