From the Guidelines
Pipeline flow diversion is a highly effective treatment for brain aneurysms, particularly for wide-neck aneurysms that are not amenable to clipping or coiling, with the guidelines evolving to greater acceptance of its use 1. The effectiveness of pipeline flow diversion for treating brain aneurysms can be attributed to its ability to redirect blood flow away from the aneurysm, promoting thrombosis within the aneurysm sac and leading to gradual occlusion and healing.
- Key benefits of pipeline flow diversion include:
- Minimally invasive endovascular procedure
- High success rates for complete aneurysm occlusion
- Effective for large or giant aneurysms, wide-necked aneurysms, and those in challenging locations
- According to the 2023 guidelines for the management of patients with aneurysmal subarachnoid hemorrhage, flow diversion is now recommended for patients with wide-neck aneurysms that are not amenable to clipping or coiling, as well as for ruptured fusiform or blister aneurysms 1.
- The procedure typically requires patients to take dual antiplatelet therapy for 3-6 months following treatment to prevent stent thrombosis, followed by aspirin indefinitely.
- Potential complications include device migration, in-stent stenosis, and delayed hemorrhage, but recovery time is shorter than traditional open surgery, with most patients returning to normal activities within days to weeks.
- It is essential to note that aneurysm obliteration within 24 hours of aSAH is likely superior to delayed treatment, particularly >3 days, as stated in the guidelines 1.
From the Research
Effectiveness of Pipeline Flow Diversion for Brain Aneurysms
- The effectiveness of pipeline flow diversion for treating brain aneurysms has been demonstrated in several studies 2, 3, 4, 5, 6.
- Flow diverters have changed the management of brain aneurysms, offering a treatment option for complex aneurysms that are refractory to conventional therapies 2.
- The Pipeline Embolization Device has been shown to have favorably low complication and high cure rates compared to alternative treatments 2.
- A pragmatic randomized care trial found that flow diversion was more effective than alternative standard management options in terms of angiographic outcome for patients with mostly unruptured, large, anterior circulation (carotid) aneurysms 3.
- Flow-diverting stents have revolutionized the treatment of complex aneurysms, triggering a cascade of gradual intra-aneurysmal thrombosis and preserving the patency of normal perforators and side branch vessels 4.
Key Findings
- The primary efficacy outcome, including the core lab-determined angiographic presence of a residual aneurysm, aneurysm rupture, progressive mass effect during follow-up, or death or dependency, was found in 30.9% of patients who underwent flow diversion and 45.6% of patients receiving alternative standard management options 3.
- Flow diversion has been shown to have high cure rates and low complication rates, making it a preferred treatment option for large or giant wide-necked proximal internal carotid artery aneurysms 6.
- Ongoing randomized studies will help to more rigorously determine the efficacy of flow diversion 6.
- The development of flow diverters has enabled the treatment of many aneurysms previously considered untreatable, and future directions in flow diversion technology include bioresorbable flow diverters, transcriptomics and radiogenomics, and machine learning and artificial intelligence 5.