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Objective: The Pipeline Embolization Device (PED) (Covidien, Irvine, CA, USA) is an endovascular microcatheter delivery system for the curative reconstruction of parent arteries harboring large/giant, wide-necked, and fusiform intracranial aneurysms. Here, we describe our initial experience with the PED to evaluate its safety, complications, and effectiveness. Methods: We retrospectively reviewed 23 consecutive patients who had received PED endovascular treatment of 23 intracranial aneurysms of the internal carotid artery between the petrous and superior hypophyseal segments between November 2015 and August 2016. Results: A total of 11 complications were experienced by nine patients with a mean follow-up period of 6.5 months. Five major complications defined as ipsilateral stroke in four patients were encountered: two procedure-related ischemic strokes, one delayed ischemic stroke, and two intracerebral hemorrhages. In one patient, the symptom was persistent 3 months post-procedure. Of the other five patients with complications, four went on to recover completely 3 months post-procedure. Overall, the total complication rate for treatment with PED was 39.1% (9/23). Morbidity rate at 3 months post-procedure was 8.7% (2/23), and mortality rate 3 months post-procedure was 0%. Angiographic follow-up examination was carried out in 10 patients at 6 months and revealed no filling (0%) of aneurysm in four patients, entry remnant (<5%) in five, and subtotal filling (5%–95%) in another patient. Conclusion: The PED placement is effective therapy for the treatment of large/giant and wide-necked intracranial aneurysms. Despite the relatively low rate of permanent complications associated with the PED, it is important to note that the total complication rate was not negligible.

A Pipeline Embolization Device for the Treatment of Large and Giant Intracranial Aneurysms: Initial Experience at a Single Center