2017 年 11 巻 3 号 p. 138-146
The indication for a Pipeline Flex in Japan is internal carotid artery aneurysms proximal to the posterior communicating artery with maximum diameter of more than 10 mm and neck of more than 4 mm. Total coverage of neck and wall apposition to the parent artery are both necessary to obtain total occlusion using a Pipeline. Nevertheless, it is not necessarily technically feasible. It becomes more challenging to appropriately deploy a Pipeline particularly if there are multiple tortuous curvatures adjacent to the aneurysm, wide-neck of more than 8 mm, or discrepancy of more than 2 mm in the proximal and distal artery. There are several reports of delayed aneurysmal rupture following flow diverter treatment for intra-dural extra-large or giant aneurysms. Coil embolization immediately after Pipeline placement is the only way to possibly prevent this fatal complication. Physicians are recommended to begin with a straightforward case by skipping these challenging aneurysms.