The Pipeline embolization procedure is a new, minimally invasive approach to treating unruptured cerebral aneurysms, including many once considered too difficult to treat. Because the Pipeline procedure treats the parent artery of the aneurysm, not the aneurysm itself, it is unlike any other option and has a shorter procedural times than other treatment options.
What Is a Pipeline Procedure?
Pipeline embolization is an endovascular procedure that uses a strategy called flow diversion to treat aneurysms in the brain. This is a very different approach that doesn’t require direct contact with the aneurysm, like standard treatments such as clipping and coiling. In clipping surgery, the skull is opened and a clip is placed across the aneurysm’s neck. Coiling, like the Pipeline, is far less invasive than surgery, but it involves placing flexible platinum wire directly into the aneurysm. Both these procedures carry a significant risk of rupturing the aneurysm during treatment.
In the Pipeline embolization procedure, no contact is made with the aneurysm, so this procedure significantly reduces the risk of rupture of the aneurysm. In a Pipeline procedure, a mesh stent called a Pipeline Embolization Device (PED) is placed into the artery at the aneurysm site through a catheter guided into the femoral artery in the groin through at the aneurysm site. The PED directs blood to flow normally through the artery instead of into the aneurysm. Before treatment, blood flows into the aneurysm. Immediately post treatment with the Pipeline Device, blood flow into the aneurysm slows. Over time, blood no longer enters the aneurysm as the body’s natural healing process works with the Pipeline device, the aneurysm shrinks.
Preparing for Your Procedure
Preparation for a Pipeline procedure begins several days before your surgery date.
You can expect to have pre-surgery testing including MRI, angiography and blood tests to establish the location and shape of your aneurysm and determine your general health status.
You will be prescribed anticoagulant (blood-thinning) medications to take for several days before your surgery to reduce the risk of blood clots during and after the procedure.
Other pre-surgery preparations include restrictions on eating or drinking in the hours before your procedure. Your doctors may also recommend changes to regular medications you take for other health conditions.
Because you can expect to remain in the hospital for a day or more, plan for time off from work or school and make arrangements for someone to drive you home when you’re released.
The Day of the Procedure
The day of the procedure, you’ll check in to the hospital. You can expect to change into a gown. The incision site may be shaved and prepped, and you will be taken to the room where the procedure will be performed.
Your endovascular surgery team includes the neurosurgeon who will place the PED, an anesthesiologist and an imaging specialist, who manages real time monitoring of the procedure. Specially trained circulating nurses prepared to assist and monitor your status throughout the procedure will be there, as well.
Before your procedure, the necessary equipment will be assembled: monitors for vital signs such as heart rate and blood pressure, necessary surgical tools and the microcatheter and PED itself. Sophisticated computerized imaging equipment assists your neurosurgeon to place the PED precisely and safely into the artery at the aneurysm site.
During the Procedure
The aneurysm Pipeline procedure is typically performed under general anesthesia to minimize movement during this delicate operation. The Pipeline procedure typically takes about an hour and a half, although in some cases it may take up to three hours. Just before the procedure, you will be connected to monitors to track heart rate, blood pressure and other vital signs during the procedure. At this time, the anesthesiologist will administer the anesthesia.
A small incision is made in the femoral artery. With the aid of contrast dye and computerized imaging guidance, your neurosurgeon will thread a long thin catheter into the artery until it reaches the site of the aneurysm. Once the catheter is in position, the PED is deployed along the artery, where it expands across the aneurysm opening and begins to divert blood through the artery. When the device is properly placed, the catheter is withdrawn and your incision is closed.
After the Procedure: Recovery in the Hospital
After your aneurysm pipeline procedure, you can expect to be taken to a recovery room for monitoring as you wake up from anesthesia. Nursing staff will check vital signs and watch for indications of any complications from the procedure. You may be given medications for pain at the incision site, nausea, headache or other symptoms. You can expect to continue taking anticoagulant medications to reduce the risk of blood clots.
Your surgeon will provide any additional instructions for your care in the hospital and at home. Once you have recovered from anesthesia, you will be moved to a standard room for the duration of your hospital stay. There, you will continue to be monitored for signs of problems.
Without complications, most people who have a Pipeline procedure are able to return home within a day or two after surgery and resume most normal activities within a week or two.
Studies show that the aneurysm Pipeline procedure can resolve 95.2 % of unruptured cerebral aneurysms, including many considered too difficult to treat by other means – and it can also resolve aneurysms when coiling has failed. Carried out by a team of specialists highly trained in endovascular procedures and neuroimaging, Pipeline embolization has revolutionized the treatment of cerebral aneurysms.