Ruptured Intracranial Aneurysms Treated with the Pipeline Embolization Device: A Systematic Review and Pooled Analysis of Individual Patient Data

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FIG 1.
Flow diagram describing the selection process by which studies were included in the analysis of treatment of ruptured intracranial aneurysms with the Pipeline Embolization Device.
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FIG 2.
Sample case of a ruptured dissecting aneurysm of the left vertebral artery treated with placement of the PED. A, CT of the head demonstrates subarachnoid hemorrhage consistent with aneurysm rupture. Note the large amount of left-sided posterior fossa SAH. B, 3D rotational angiography of the left vertebral artery shows the dissecting aneurysm (arrow). C, Left vertebral artery angiogram shows the dissecting aneurysm (arrow). C, Left vertebral artery angiogram demonstrates contrast stasis in the dissecting aneurysm (arrow) following PED placement.

Table 1:

Summary of the patient treatment and outcome data from the 12 included studies

Authors and Year	Treatment		Follow-Up (mo)	Rerupture	Occluded	mRS		Complications
Authors and Year	PED Only	PED + Coiling	Follow-Up (mo)	Rerupture	Occluded	0–2	3–5	Death	All
Capocci et al,¹³ 2020	6/6	0/6	18.0	0/6	5/5	5/6	1/6	0/6	1/6
Lozupone et al,² 2018	12/14	2/14	NR	0/14	12/12	10/14	3/14	1/14	2/14
Cerejo et al,⁷ 2017	8/8	0/8	7.2	0/8	6/8	6/7	1/7	0/8	2/8
Linfante et al,³ 2017	10/10	0/10	15.2	0/10	9/9	8/10	1/10	1/10	1/10
Ryan et al,⁴ 2017	13/13	0/13	3.0	0/13	5/10	10/13	1/13	2/13	5/13
Chalouhi et al,¹¹ 2015	14/20	6/20	5.3	0/20	12/15	19/20	0/20	1/20	1/20
Lin et al,⁹ 2015	14/26	12/26	10.1	1/26	19/23	20/26	3/26	3/26	3/26
Chan et al,⁵ 2014	6/8	2/8	5.0	0/8	8/8	NR^{^a}	NR^{^a}	0/8	1/8
Yoon et al,⁸ 2014	9/11	2/11	4.8	0/11	7/8	9/10	0/10	1/11	4/11
Cinar et al,⁶ 2013	6/6	0/6	7.0	0/6	6/6	4/6	2/6	0/6	0/6
McAuliffe et al,¹⁰ 2012	6/11	5/11	6.0	2/11	8/9	8/11	1/11	2/11	3/11
de Barrios Faria et al,¹² 2011	5/12	7/12	6.0	0/12	8/12	NR^{^a}	NR^{^a}	0/12	0/12
Total	109/145	36/145		3/139	105/120	99/123	13/123	11/139	23/139
Range			3–18

Note:—NR indicates not reported.
↵a Reported Glasgow Outcome Scale scores: grades 1–3: 3/8 (Chan et al), 6/12 (de Barrios Faria et al); grades 4–5: 5/8 (Chan et al), 6/12 (de Barrios Faria et al).

Table 2:

Details regarding all 3 patients with Pipeline Embolization Device–related intracranial hemorrhage

Authors and Year	Sex	Age (yr)	Clinical Score	Treatment Time	Aneurysm Size (mm)	Aneurysm Location	Aneurysm Morphology	Treatment Method	Procedure and Complication Details
Lin et al,⁹ 2015	NR	Mid-30s	HH 2	Acute	3	Paraclinoid ICA	Saccular	PED only	Treatment complicated by in-stent thrombosis treated with intra-arterial tPA; patient died of re-hemorrhage on posttreatment day 1
McAuliffe et al,¹⁰ 2012	F	56	WFNS II	Acute	21	Superior hypophyseal	Saccular	PED only	Two PEDs deployed with plans for adjuvant coiling; however, in-stent thrombosis was seen and treated with intra-arterial abciximab; patient experienced rerupture on day 8 with vasospasm of ipsilateral M1 segment, treated with balloon angioplasty and 3rd PED; patient died 3 days later
McAuliffe et al,¹⁰ 2012	F	37	WFNS V	Acute	34	Dorsal paraclinoid ICA	Fusiform	PED only	Two PEDs telescoped across the aneurysms, which re-ruptured immediately after deployment of the second device; active treatment was withdrawn