To evaluate the safety and efficacy of Pipeline embolization device (PED) in the treatment of large intracranial aneurysms (LIA) and giant intracranial aneurysms (GIA).

A retrospective analysis was conducted on the clinical data of 35 patients with LIA and GIA who received PED treatment in the Neurosurgery Department of the First Affiliated Hospital of Xinjiang Medical University from October 2019 to March 2024. The surgical methods, perioperative complications, and imaging results of the patients were collected. During postoperative and follow-up periods, DSA was used to assess the recurrence of aneurysms, Kamran occlusion grading criteria were used to evaluate the degree of aneurysm occlusion, and modified Rankin scale (mRS) was used to evaluate neurological function prognosis.

Among the 35 patients, 32 (91.4%) had unruptured aneurysms and 3 (8.6%) had ruptured aneurysms. Thirty-six PEDs were successfully implanted during the operation, including 1 case of double stent implantation. Sixteen patients received simple PED implantation, 19 patients received PED combined with coil embolization, and 1 patient with ruptured aneurysm and proximal stenosis underwent balloon dilation treatment. Two patients experienced complications during the perioperative period, with an incidence rate of 5.7%. Postoperative Kamran grading showed 12 cases at grade 1, 18 cases at grade 2, and 5 cases at grade 3. At discharge, the mRS score showed that 31 cases scoring 1, 1 case scoring 3, 1 case scoring 4, and 2 cases scoring 5. The follow-up period was 5-53 months (median 9 months), and a total of 30 patients completed the follow-up. The mRS score showed that 22 cases scoring 0, 7 cases scoring 1, and 1 case scoring 2; Kamran grading shows 3 cases at grade 2, 4 cases at grade 3, and 23 cases at grade 4.

PED treatment has a high technical success rate and good safety for LIA and GIA surgeries, but the risk of perioperative complications still needs to be monitored.