Medtronic's Pipeline Embolization Device Evaluated in Treatment of Ruptured Intracranial Aneurysms

November 11, 2015—In the Journal of NeuroInterventional Surgery (JNIS), Ning Lin, MD, et al published findings from an evaluation of safety and effectiveness data from use of the Pipeline embolization device (Medtronic plc) in complex ruptured aneurysms at five participating centers in the United States (2015;7:808–815). The investigators retrospectively reviewed records of patients with ruptured cerebral aneurysms who underwent Pipeline treatment between 2011 and 2013.

As summarized in JNIS, the investigators reported that 26 patients with ruptured aneurysms underwent Pipeline embolization treatment (mean age, 51.4 ± 13.2 years; 16 women). At presentation, eight patients (30.8%) had a Hunt and Hess grade of 4 or more; 11 patients required extraventricular drain placement. The aneurysm morphologies included eight dissecting, eight blister-like, six fusiform, and four saccular. There were 22 anterior circulation and four posterior circulation aneurysms.

Pipeline device deployment was successful in all patients, with adjunctive coiling utilized in 12 patients. Periprocedural complications occurred in five patients (19.2%), including three in-hospital deaths. There were 23 patients (88.5%) with postoperative angiography at a mean of 5.9 months: 18 aneurysms (78.3%) were completely occluded, three (13%) had residual neck filling, and two (8.7%) had residual dome filling. 

All blister-type aneurysms were completely occluded at follow-up. Clinical follow-up was available for an average of 10.1 months (range, 2–21 months), with one asymptomatic in-stent stenosis and one asymptomatic thromboembolic stroke noted. Good outcome (modified Rankin Scale [mRS] score of 0–2) was achieved in 20 patients (76.9%), fair (mRS 3–4) in three (11.5%), and three died (11.5%).

The investigators concluded that the Pipeline embolization device can be utilized for ruptured aneurysms and is a good option for blister-type aneurysms. However, they noted that due to periprocedural complications, it should be reserved for lesions that are difficult to treat by conventional clipping or coiling.