Pipeline Flex with Shield Technology Placement for Small- and Medium-sized Aneurysms Achieves Early Complete Occlusion

The flow diverter has been shown to be a safe and effective device for large cerebral aneurysms in the proximal internal carotid artery (ICA). Recently, its indication has been expanded to small-and medium-sized cerebral aneurysms in the distal segment of the ICA. In this study, we report a single-center, retrospective investigation of the safety and efficacy of the Pipeline Flex device to treat these aneurysms. Of the patients who underwent Pipeline implantation for small-and medium-sized ICA aneurysms (<_12 mm) at our hospital between July 2013 and October 2021, 102 patients with 104 aneu-rysms were included in this study. The mean age of the patients was 57.7 +/- 12.1 years, and 94 (90.4%) were female. The mean aneurysmal dome diameter was 9.2 +/- 2.3 mm, the mean neck diameter was 5.3 +/- 1.6 mm, and the mean dome-to-neck ratio was 1.8 +/- 0.5. Twenty-five patients (24.0%) had incorpo-rated vessels from the aneurysm. Complete occlusion of the aneurysms was obtained in 96 patients (92.3%). There were no cases of parent artery stenosis or major stroke after the procedure. Absence of incorporated vessel from the aneurysm dome and adjunctive coil embolization are statistically signifi-cant factors indicating complete occlusion in multivariate analysis. The time to complete occlusion was determined earlier with the use of the Pipeline Shield (p = 0.0386) and with adjunctive coils (p = 0.0025). We showed that Pipeline implantation for small-and medium-sized aneurysms was safe and highly effective.