Safety and efficacy of the pipeline vantage flow diverter in small cerebral vessels ≤2.5 mm: a case series

Abstract Background The Pipeline Vantage Flow Diverter (PVFD) with shield technology is the fourth and latest generation of the Pipeline embolization devices which are flow diverting stents used in the treatment of cerebral aneurysms. In early 2025 the larger PVFD 027s were recalled due to concerns of braid deformities with updated instructions provided for the PVFD 021. This study aimed at evaluating the safety and efficacy of the PVFD for cerebral aneurysm treatment in small parent vessels ≤ 2.5 mm. Methods A retrospective review of patients who received a 2.5 mm diameter PVFD for cerebral aneurysm treatment at our institution over 4 years was performed. Baseline patient characteristics, complications, clinical and radiological outcomes were collected for each patient with a mean follow up duration of 1 year and 17 days (median 7 months and 5 days). Results There were a total of 14 patients identified with a total of 16 aneurysms treated. At latest follow up complete aneurysm occlusion was achieved in 10 (66.7%) out of 16 treated aneurysms with 1 patient still awaiting follow up imaging. There were 2 (14.3%) of 14 patients who had immediate neurological complications, of which 1 was a transient deficit, and 0 patients with delayed complications. In-stent stenosis was found in 2 (15.4%) of 13 patients and asymptomatic stent occlusion occurred in 1 patient (7.69%). Conclusions This case series demonstrated an acceptable safety profile with reasonable aneurysm occlusion rates for the use of PVFD in cerebral vessels ≤ 2.5 mm in treating aneurysms.