Pipeline embolization device in treating middle cerebral artery aneurysms: a single-center experience in 69 consecutive patients.

Purpose: The pipeline embolization device (PED) has been established as an effective treatment option for aneurysms within its designated indications. Recently, its off-label applications, including treating middle cerebral artery (MCA) aneurysms, have increased. This study augmented the current literature by examining the outcomes of PED utilization for MCA aneurysms.

Methods: We collected data from consecutive patients with MCA aneurysms treated with PED between June 2016 and December 2021. Particularly, we collected data on patient demographics, aneurysm characteristics, procedural details, perioperative complications, and clinical and angiographic follow-up results.

Results: A total of 69 patients (mean age 47.4 years; 42.0% female) with MCA aneurysms who underwent PED treatment were included in this study. Among these, 5 aneurysms had ruptured previously, and 10 patients had previously undergone open surgery or received endovascular treatment. In the last angiographic follow-up, conducted at a mean of 19.0 ± 13.5 months, 44 of 56 (78.6%) aneurysms achieved complete occlusion. Ten (17.9%) and three (5.4%) patients exhibited in-stent stenosis and MCA occlusion, respectively. During a mean clinical follow-up period of 35.1 months, 10 of 63 patients (15.8%) experienced major procedure-related complications, including 2 hemorrhagic (3.2%) and 8 ischemic (12.7%) events.

Conclusion: PED is a viable treatment for MCA aneurysms, particularly those with fusiform and wide-necked characteristics that pose challenges for traditional open surgery. PED shows favorable clinical outcomes and occlusion rates and presents a notable risk of complications and in-stent restenosis. Therefore, careful patient selection is crucial when using PEDs to treat MCA aneurysms.