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Background The Pipeline embolization device (PED) has expanded the range of aneurysms amenable to endovascular treatment, including some that were previously untreatable. The PED contains several metals, including nickel, cobalt, chromium, platinum, and tungsten. The safety of PED implantation in patients with cutaneous metal allergy is unknown. The aim of this study was to assess clinical and angiographic outcomes of PED treatment in patients with cutaneous metal allergy. Methods A single-institution neurointerventional database was retrospectively reviewed for patients with documented cutaneous metal allergy who were treated with the PED. Patient, aneurysm, and procedural data were collected, including perioperative and delayed complications. Posttreatment angiograms were reviewed for in-Pipeline stenosis and aneurysm occlusion. Results Twenty patients with metal allergy underwent 23 PED treatments for 26 aneurysms. The cohort was 95% (19/20) female; mean age was 55.7 years. Aneurysms were primarily anterior circulation (92%, 24/26) and saccular (92%; 24/26); mean size was 8.8 mm (range, 2–32 mm). One PED was implanted in 70% (14/20) of patients, 25% (5/20) had 2 devices placed, and 1 patient had 3 devices. One major procedural complication occurred (4.3%, 1/23) in which a stroke was caused by perioperative PED thrombosis. Angiographic follow-up was available for all patients (mean duration 15.7 months; range, 6–64 months), which demonstrated a complete aneurysm occlusion rate of 88% (23/26). Asymptomatic in-Pipeline stenosis occurred in 2 cases, resulting in 65% and 50% parent artery stenosis, respectively. Conclusions Preliminary results suggest that PED implantation in patients with cutaneous metal allergy is safe and effective.

The Scepter XC balloon catheter can be used for balloon-assisted coiling (BAC) of cerebral aneurysms but also accommodates delivery of a low-profile visible intraluminal stent (LVIS Jr.). We assessed the safety and effectiveness of BAC using the Scepter XC, with LVIS Jr. stent-assisted coiling (SAC) as a bailout option.A single-institution prospectively maintained neurointerventional database was reviewed for wide-necked (neck width ≥4 mm or dome/neck ratio2) saccular aneurysms treated using the Scepter XC. Complication and angiographic occlusion rates of BAC and SAC procedures were compared. Multivariate logistic regression was used to identify variables predictive of complete aneurysm occlusion.The cohort included 141 wide-necked saccular intracranial aneurysms treated in 135 procedures. SAC was used to treat 30% of aneurysms by deploying the LVIS Jr. through the Scepter XC. The overall procedural complication rate was 8.9%, including a 1.5% rate of symptomatic thromboembolic events and 3.0% rate of hemorrhagic complications, with no significant differences in complications between BAC and SAC procedures (P = 0.27). The overall complete or near-complete aneurysm occlusion rate was 96%, with trends toward higher complete aneurysm occlusion and lower retreatment rates with SAC (78 vs. 57%; P = 0.13; 0 vs. 8.4%, P = 0.13). Multivariate logistic regression identified aneurysm size, procedure technique (BAC or SAC), and duration of follow-up as independent predictors of complete aneurysm occlusion.Use of the Scepter XC for BAC, with LVIS Jr. SAC as a bailout option, shows acceptable angiographic and clinical results.