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Study Supports Use of Flow-Diverting Stent for Complex Brain Aneurysms in Children

Study Supports Use of Flow-Diverting Stent for Complex Brain Aneurysms in Children 1024 531 Lauren Dembeck
MRA Brain or Magnetic resonance angiography (MRI) of Vessel in the brain sagittal view for evaluate them stenosis

New research suggests that a minimally invasive flow-diversion device approved for adults may offer a safe and effective treatment option for children with complex brain aneurysms.

Pediatric intracranial aneurysms are rare, but when they occur, they can be among the most challenging cerebrovascular conditions to treat. Many have complex morphologies and locations that may not be amenable to conventional microsurgical reconstruction or endovascular approaches.

New research from Nationwide Children’s Hospital and The Ohio State University suggests that the Pipeline Embolization Device (PED), an endovascular implant currently approved for use in adults, may provide a safe and effective treatment option for selected children with these complex aneurysms.

“Adults tend to develop aneurysms because of factors like high blood pressure and smoking,” says Eric A. Sribnick, MD, PhD, pediatric neurosurgeon at Nationwide Children’s and professor of neurological surgery at The Ohio State University College of Medicine. “In children, you can certainly have aneurysms that develop spontaneously, but around one-third of these patients have a family history or a genetic condition that makes them more likely to develop an aneurysm.”

In a systematic review and institutional study published in Neurosurgery, the researchers compared outcomes among 114 pediatric patients with data from 2,098 adults treated with the PED. They found no significant differences in major complications or neurologic mortality. Complete aneurysm occlusion, meaning no residual blood flow into the aneurysm, occurred in 92.0% of pediatric cases, compared with 76.7% of adult cases. The study represents the largest cohort of pediatric patients treated with the device reported to date.

Before the development of flow-diversion technologies, treatment options were often limited to open surgery with craniotomy or coil embolization, a minimally invasive procedure in which small coils are placed inside the aneurysm to promote clotting and prevent rupture. The PED is a flow-diverting stent placed within the blood vessel that gives rise to the aneurysm.

“Flow diversion is a novel way of treating aneurysms. Rather than directly treating the aneurysm itself, the device reroutes blood flow away from the weakened area, allowing the aneurysm to gradually clot off over time, so it won’t rupture,” Dr. Sribnick says. “Flow diverters are yet another option in our armamentarium for treating these aneurysms, and in many cases, it works very well.”

Because data on flow-diversion therapy in very young children remain limited, the researchers also examined outcomes by age. They found no significant differences in safety or efficacy between younger and older pediatric patients when stratified by ages 0–10 to 11–18 years, as well as ages 0–5 to 6–18 years, providing additional reassurance regarding the use of the technology in younger children.

“We tend to see that many repair processes occur more robustly in children than in adults,” adds Patrick P. Youssef, MD, pediatric neurosurgeon and neurointerventional specialist at Nationwide Children’s and associate professor of neurological surgery at The Ohio State University College of Medicine. “In essence, flow diversion uses the body’s natural repair mechanisms and allow the affected vessel to endothelialize and restore more normal anatomy.”

Within the Nationwide Children’s cohort of 10 pediatric patients with 11 intracranial aneurysms treated with PED, no major complications were reported. All treated aneurysms achieved complete occlusion on follow-up imaging at 6 months, and all patients had favorable neurologic outcomes at last follow-up.

Beyond the results themselves, the team believes the work reflects broader advances in pediatric neurovascular care.

“I think it really speaks to the changing landscape of pediatric neurosurgery in terms of how we are treating patients with vascular pathology,” Dr. Sribnick says. “It also speaks to the great collaboration we have with our adult colleagues that allows us to both use these emerging therapies and perform this type of research.”

“It is paramount to be able to successfully translate the usage of these devices for safe and effective treatment of a vulnerable pediatric population,” Dr. Youssef says. “This allows patients to be treated in a non-invasive manner with a simple needle stick rather than a more complex and risky open surgical procedure. The treatment process will continue to evolve and become safer and more effective in the future.”

 

 

Reference:

Cuoco JA, Gruber MD, Bhenderu LS, Ritchey N, Schunemann V, Kim JE, Shaikhouni A, Pindrik JA, Nimjee SM, Leonard JR, Powers CJ, Sribnick EA, Youssef PP. The Safety and Efficacy of Pipeline Embolization in Pediatric Intracranial Aneurysms: A Systematic Review and Institutional Experience. Neurosurgery. 2026 Mar 27. doi: 10.1227/neu.0000000000004014.

About the author

Lauren Dembeck, PhD, is a freelance science and medical writer based in New York City. She completed her BS in biology and BA in foreign languages at West Virginia University. Dr. Dembeck studied the genetic basis of natural variation in complex traits for her doctorate in genetics at North Carolina State University. She then conducted postdoctoral research on the formation and regulation of neuronal circuits at the Okinawa Institute of Science and Technology in Japan.

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