Off-label uses of the Pipeline embolization device: a review of the literature

Abstract

The Pipeline embolization device (PED) is the most widely used flow diverter in endovascular neurosurgery. In 2011, the device received FDA approval for the treatment of large and giant aneurysms in the internal carotid artery extending from the petrous to the superior hypophyseal segments. However, as popularity of the device grew and neurosurgeons gained more experience, its use has extended to several other indications. Some of these off-label uses include previously treated aneurysms, acutely ruptured aneurysms, small aneurysms, distal circulation aneurysms, posterior circulation aneurysms, fusiform aneurysms, dissecting aneurysms, pseudoaneurysms, and even carotid-cavernous fistulas. The authors present a literature review of the safety and efficacy of the PED in these off-label uses.

Keywords: ACA = anterior cerebral artery; ACoA = anterior communicating artery; CCA = cavernous carotid aneurysm; CCF = carotid-cavernous fistula; ICA = internal carotid artery; MCA = middle cerebral artery; PED = Pipeline embolization device; PRU = P2Y12 reaction unit; Pipeline embolization device; SAH = subarachnoid hemorrhage; aneurysms; mRS = modified Rankin Scale; off-label uses.