{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T12:16:52Z","timestamp":1773317812334,"version":"3.50.1"},"reference-count":30,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2019,5,6]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Flow diverters are a breakthrough treatment for large and giant intracranial aneurysms but carry a risk of periprocedural death or major stroke. Pipeline Flex is a second-generation device that is thought to have lower complication rates because of improvements in the delivery system as well as increased operator experience. Our objective was to analyze the risk of periprocedural death or major complications using Pipeline Flex for unruptured intracranial aneurysms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic search of three databases was performed for studies of \u226510 treatments using Pipeline Flex for unruptured intracranial aneurysms (2014\u20132019) using PRISMA guidelines. Random effects meta-analysis was used to pool the rates of periprocedural (&lt;30 days) death, major ischemic stroke, symptomatic intracranial hemorrhage, and minor stroke\/transient ischemic attack.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included eight studies reporting 901 treatments in 879 patients. Periprocedural mortality (&lt;30 days) was 0.8% (5\/901; 95%\u2009CI 0.4% to 1.5%; I<jats:sup>2<\/jats:sup>=0%). Rate of major complications (death, major ischemic stroke, or symptomatic intracranial hemorrhage) was 1.8% (14\/901; 95%\u2009CI 1.0% to 2.7%; I<jats:sup>2<\/jats:sup>=0%). Aneurysm size \u226510\u2009mm was a statistically significant predictor of a major complication (OR 6.4; 95%\u2009CI 2.0 to 20.7; p=0.002). Risk of a major complication in aneurysms &lt;10\u2009mm was 0.9% (95% CI 0.3% to 1.7%; I<jats:sup>2<\/jats:sup>=0%). The meta-analysis was limited by the predominance of anterior circulation aneurysms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Treatment of unruptured intracranial aneurysms using the Pipeline Flex flow diverter has a low periprocedural risk of death (0.8%) or major complication (1.8%). The risk of a major complication is significantly higher for large\/giant aneurysms (4.4%) and is very low for aneurysms &lt;10\u2009mm (0.9%).<\/jats:p><\/jats:sec>","DOI":"10.1136\/neurintsurg-2019-014937","type":"journal-article","created":{"date-parts":[[2019,5,30]],"date-time":"2019-05-30T21:19:48Z","timestamp":1559251188000},"page":"817-824","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["Periprocedural complications of second-generation flow diverter treatment using Pipeline Flex for unruptured intracranial aneurysms: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3431-5647","authenticated-orcid":false,"given":"Kartik Dev","family":"Bhatia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans","family":"Kortman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Orru","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesse M","family":"Klostranec","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vitor M","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"Krings","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,5,30]]},"reference":[{"key":"2024052305130267000_11.8.817.1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.678151"},{"key":"2024052305130267000_11.8.817.2","doi-asserted-by":"publisher","DOI":"10.3171\/2017.3.FOCUS16450"},{"key":"2024052305130267000_11.8.817.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199812103392401"},{"key":"2024052305130267000_11.8.817.4","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2016-012261"},{"key":"2024052305130267000_11.8.817.5","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2018-000150"},{"key":"2024052305130267000_11.8.817.6","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1177\/1591019916681981","article-title":"Use of self-expanding stents for better intracranial flow diverter wall apposition","volume":"23","author":"K\u00fchn","year":"2017","journal-title":"Interv Neuroradiol"},{"key":"2024052305130267000_11.8.817.7","doi-asserted-by":"publisher","DOI":"10.3171\/2012.4.JNS111660"},{"key":"2024052305130267000_11.8.817.8","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2014-011347"},{"key":"2024052305130267000_11.8.817.9","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.3171\/2017.7.JNS171289","article-title":"Declining complication rates with flow diversion of anterior circulation aneurysms after introduction of the Pipeline Flex: analysis of a single-institution series of 568 cases","volume":"129","author":"Colby","year":"2018","journal-title":"J Neurosurg"},{"key":"2024052305130267000_11.8.817.10","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2015-011894"},{"key":"2024052305130267000_11.8.817.11","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1007\/s00234-017-1930-z","article-title":"Clinical and angiographic outcomes in patients with intracranial aneurysms treated with the pipeline embolization device: intra-procedural technical difficulties, major morbidity, and neurological mortality decrease significantly with increased operator experience in device deployment and patient management","volume":"59","author":"Delgado Almandoz","year":"2017","journal-title":"Neuroradiology"},{"key":"2024052305130267000_11.8.817.12","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ensci.2019.01.004","article-title":"Thrombogenicity assessment of Pipeline, Pipeline Shield, Derivo and P64 flow diverters in an in vitro pulsatile flow human blood loop model","volume":"14","author":"Girdhar","year":"2019","journal-title":"eNeurologicalSci"},{"key":"2024052305130267000_11.8.817.13","doi-asserted-by":"publisher","DOI":"10.1159\/000486538"},{"key":"2024052305130267000_11.8.817.14","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Gald\u00e1mez M , Lamin SM , Lagios KG , et al . Treatment of intracranial aneurysms using the pipeline flex embolization device with shield technology: angiographic and safety outcomes at 1-year follow-up. 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