BMJ Case Reports 2017; doi:10.1136/bcr-2017-219406
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

First US experience with Pipeline Flex with Shield Technology using aspirin as antiplatelet monotherapy

  1. Eric Sauvageau1
  1. 1 Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
  2. 2 Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
  1. Correspondence to Dr Ricardo A Hanel, rhanel{at}
  • Accepted 22 April 2017
  • Published 4 May 2017


Flow diversion has revolutionised the treatment of intracranial aneurysms, and the Pipeline Embolization Device (PED) remains the only flow diverter (FD) approved in the USA. However, thromboembolic events remain an issue for FDs. Attempting to minimise these incidents, a newer PED has been developed with the use of covalent bonding of phosphorylcholine onto the Pipeline device that has been known as Shield Technology (PED Shield), which in vitro has demonstrated a significant reduction in material thrombogenicity. We report the first US experience of the PED Shield in the treatment of a ruptured fusiform aneurysm located in the right vertebral artery in an attempt to mitigate complications related to the use of dual-antiplatelet therapy and discuss our rationale for using the new FD, using aspirin only as the antiplatelet regimen.


  • Contributors RAH and PA-S were responsible for study concept and design. PA-S contributed to the acquisition of the data. All the authors were responsible for analysis and interpretation of the data. PA-S and LBCB contributed to the drafting of the manuscript. RAH and ES contributed to the critical revision of the manuscript for important intellectual content. PA-S and LB were responsible for administrative, technical and material support. RAH and ES contributed to study supervision.

  • Competing interests RAH is a consultant for Covidien, Stryker, Codman, MicroVention and scientific advisory board for Medina Medical and shareholder for Blockade Medical. The other authors have no personal, financial or institutional interest in any of the drugs, materials or devices described in this article.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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