Pipeline embolization device with adjunctive coiling for ruptured blood blister-like aneurysms: a multicenter study focusing on Hunt-Hess grade I–III patients
- 1Department of Neurosurgery, Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University
- 2Department of Neurosurgery, Guangdong Sanjiu Brain Hospital
- 3Department of Neurosurgery, Shengjing Hospital of China Medical University
Abstract
Background: Blood blister-like aneurysms (BBAs) of the internal carotid artery are rare and inherently unstable lesions that carry a high risk of rebleeding. Evidence regarding the outcomes of Pipeline embolization device (PED)-assisted coiling specifically in patients with mild-to-moderate neurological deficits (Hunt-Hess grade I-III) remains limited.
Methods: This multicenter retrospective study, conducted at three comprehensive stroke centers between January 2018 and December 2023, included 28 consecutive patients with ruptured ICA BBAs. We evaluated the safety and efficacy of PED combined with adjunctive coil embolization using a deliberate loose-scaffolding strategy.
Results: Technical success was achieved in 100% of cases. Immediate complete angiographic occlusion (modified Raymond-Roy class I) was observed in 67.9% (19/28), increasing to 75.0% (21/28) overall at 12 months and reaching 95.5% (21/22) among those with available imaging follow-up. Notably, all seven patients with residual neck filling on immediate postoperative angiography who completed follow-up subsequently achieved complete occlusion. Favorable clinical outcome (modified Rankin Scale 0-2) was recorded in 92.9% (26/28) at last follow-up. Perioperative complications occurred in 39.3% (11/28), predominantly neurological, including symptomatic vasospasm (21.4%, 6/28) and cerebral infarction (14.3%, 4/28); perioperative mortality was 3.6% (1/28).
Conclusion: PED-assisted coil embolization with a loose-scaffolding strategy is technically feasible and may yield favorable outcomes in selected patients with mild-to-moderate neurologic deficits. However, given the retrospective, single-arm design and modest sample size, these results are hypothesis-generating; prospective comparative studies are warranted.
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BibTeX
@article{wang2026pipeline,
title = {{Pipeline embolization device with adjunctive coiling for ruptured blood blister-like aneurysms: a multicenter study focusing on Hunt-Hess grade I–III patients}},
author = {Peiming Wang and Jie Liu and Huaitao Yuan and Feng Xu and Wei Tang and Qiming Li and Lukui Chen},
journal = {Frontiers in Neurology},
year = {2026},
month = nov,
doi = {10.3389/fneur.2026.1976238},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1976238/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Pipeline embolization device with adjunctive coiling for ruptured blood blister-like aneurysms: a multicenter study focusing on Hunt-Hess grade I–III patients
AU - Peiming Wang
AU - Jie Liu
AU - Huaitao Yuan
AU - Feng Xu
AU - Wei Tang
AU - Qiming Li
AU - Lukui Chen
PY - 2026
DA - 2026/11/02
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1976238
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1976238/full
AB - Background: Blood blister-like aneurysms (BBAs) of the internal carotid artery are rare and inherently unstable lesions that carry a high risk of rebleeding. Evidence regarding the outcomes of Pipeline embolization device (PED)-assisted coiling specifically in patients with mild-to-moderate neurological deficits (Hunt-Hess grade I-III) remains limited. Methods: This multicenter retrospective study, conducted at three comprehensive stroke centers between January 2018 and December 2023, included 28 consecutive patients with ruptured ICA BBAs. We evaluated the safety and efficacy of PED combined with adjunctive coil embolization using a deliberate loose-scaffolding strategy. Results: Technical success was achieved in 100% of cases. Immediate complete angiographic occlusion (modified Raymond-Roy class I) was observed in 67.9% (19/28), increasing to 75.0% (21/28) overall at 12 months and reaching 95.5% (21/22) among those with available imaging follow-up. Notably, all seven patients with residual neck filling on immediate postoperative angiography who completed follow-up subsequently achieved complete occlusion. Favorable clinical outcome (modified Rankin Scale 0-2) was recorded in 92.9% (26/28) at last follow-up. Perioperative complications occurred in 39.3% (11/28), predominantly neurological, including symptomatic vasospasm (21.4%, 6/28) and cerebral infarction (14.3%, 4/28); perioperative mortality was 3.6% (1/28). Conclusion: PED-assisted coil embolization with a loose-scaffolding strategy is technically feasible and may yield favorable outcomes in selected patients with mild-to-moderate neurologic deficits. However, given the retrospective, single-arm design and modest sample size, these results are hypothesis-generating; prospective comparative studies are warranted.
SN - 1664-2295
ER -