title: Pipeline Embolization Device for Small Intracranial Aneurysms: Evaluation of Safety and Efficacy in a Multicenter Cohort.
abstract: To date, the use of the flow-diverting Pipeline Embolization Device (PED) for small intracranial aneurysms (≤ 7 mm) has been reported only in single-center series.
  
  
  
  To evaluate the safety and efficacy of the PED in a multicenter cohort.
  
  
  
  Five major academic institutions in the United States provided data on patient demographics, aneurysm features, and treatment characteristics of consecutive patients with aneurysms ≤ 7 mm treated with a PED between 2009 and 2015. Radiographic outcome was assessed with digital subtraction angiography. Clinical outcome was measured with the modified Rankin Scale.
  
  
  
  The cumulative number of aneurysms ≤ 7 mm treated with PED at the 5 institutions was 149 in 117 patients (age, 54 years [range, 29-87 years]; male to female, 1-5.9). Aneurysms were most commonly located in the paraophthalmic segment (67.1%) of the internal carotid artery. Radiographic outcome at last follow-up was available for 123 aneurysms (82.6%), with a complete occlusion rate of 87%. Thromboembolic and symptomatic procedural complications occurred in 8.7% and 6% of the aneurysms treated, respectively. There was 1 mortality (0.9%) unrelated to the PED procedure. Multivariable logistic regression identified size < 4 mm, balloon angioplasty to open the device, and simultaneous treatment of multiple aneurysms as predictors of procedural complications. Good clinical outcome was achieved in 96% of electively treated patients.
  
  
  
  In the largest series on PED for small aneurysms to date, data suggest that treatment with the flow-diverting PED is safe and efficacious, with complication rates comparable to those for traditional endovascular techniques.
authors.affiliation: Neurosurgical Service, Beth Israel Dea-coness Medical Center, Harvard Medic-al School, Boston, Massachusetts.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Neurosurgical Service, Beth Israel Dea-coness Medical Center, Harvard Medic-al School, Boston, Massachusetts.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.affiliation: Dep-artment of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Foreman
authors.affiliation: Harvard Medical School, Bost-on, Massachusetts.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Chua
authors.affiliation: Dep-artment of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Harrigan
authors.affiliation: Department of Neur-osurgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: Lucy
authors.initials: L
authors.lastname: He
authors.affiliation: Department of Neur-osurgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Fusco
authors.affiliation: Department of Neurosu-rgery, Mount Sinai Hospital, New York, New York.
authors.forename: J D
authors.initials: JD
authors.lastname: Mocco
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Stapleton
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Aman B
authors.initials: AB
authors.lastname: Patel
authors.affiliation: Department of Neurosurgery, Univ-ersity at Buffalo, Buffalo, New York.
authors.forename: Ashish
authors.initials: A
authors.lastname: Sonig
authors.affiliation: Department of Neurosurgery, Univ-ersity at Buffalo, Buffalo, New York.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: Neurosurgical Service, Beth Israel Dea-coness Medical Center, Harvard Medic-al School, Boston, Massachusetts.
authors.forename: Ajith J
authors.initials: AJ
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016896:Treatment Outcome
keywords: Aneurysm; Embolization; Endovascular; Intracranial; Pipeline embolization device; Small