The pipeline embolization procedure is a relatively new and generally safe way to treat unruptured cerebral aneurysms, including those once considered too difficult to treat.
What Is a Pipeline Embolization Procedure?
An aneurysm is a weak place in the wall of an artery in the brain. This weakened area fills with blood and balloons outward from the parent artery. Aneurysms can range in size from very small to large sizes and can have a variety of shapes. Whatever their form, aneurysms can enlarge, bleed or rupture, causing stroke or even death.
Until relatively recently, aneurysms were generally treated either by surgery to place a springy metal clip across the “neck” of the aneurysm to deprive it of a blood supply, or by coiling – inserting flexible wire into the aneurysm to fill it.
Instead, the pipeline procedure aims to restructure the artery that feeds the aneurysm, rather than intervening in the aneurysm itself. In a pipeline embolization procedure, a catheter is threaded through a small incision in the femoral artery in the groin to a point adjacent to the aneurysm. There, a wire mesh device called a pipeline Embolization Device, or PED, is inserted through the catheter into the artery across the neck of the aneurysm. The PED allows blood to flow normally through the artery, but stops blood from flowing into the aneurysm, so that the aneurysm eventually disappears.
Preparation for Your Recovery Begins Before Surgery
A smooth recovery from pipeline surgery begins even before the procedure takes place. The procedure typically takes from an hour and a half to three hours, usually under general anesthesia and most people who have the pipeline procedure spend at least one night in the hospital.
Before your surgery day, plan for time off from work or school and make sure someone is available to care for any dependents you may have. For the first few days after the procedure, you will need to avoid strenuous activities and heavy lifting, so plan to have someone you can rely on to help with household chores and other tasks. Because driving is off limits during that period, make arrangements for any transportation you might need, too.
In the days leading up to surgery, you will be asked to begin taking anticoagulant (blood thinning) medications such as Plavix or aspirin and continue them throughout your recovery. Discuss these and other medications with your doctor to make sure that you take them properly before surgery and while you recover at home.
Recovering in the Hospital
A pipeline procedure is typically performed with general anesthesia, so you can expect to remain in the hospital for a day or two while the staff monitors your vital signs and checks for any complications from anesthesia or the procedure itself. Make sure you have someone available to drive you home from the hospital when you’re ready to be discharged.
Recovering at Home
You will be able to return to your daily activities about one to two weeks after your pipeline procedure.
The First Week Post-Surgery
Your doctors will advise you to take it easy and keep chores and activities to a minimum. You may experience headaches and fatigue. During this period, you will have instructions for caring for your incision and you will continue taking anticoagulant medication and any other medications that your doctors prescribe for your recovery.
The Second Week Post-Surgery
In the second week after your surgery, you can begin driving again and will be able to return to work or school unless these activities involve strenuous activity or heavy lifting. You may still experience fatigue or headache and your incision may still be healing. You can expect to continue taking anticoagulant medications to prevent blood clotting and your doctor will inform you if you can resume taking any other medications on your usual schedule.
One Month After Surgery — and Beyond
During the weeks following pipeline surgery, you will see your surgeon and healthcare team for follow-ups to check your progress. After a successful pipeline procedure, an aneurysm typically shrinks and disappears within six weeks to six months and you can expect to undergo imaging tests such as a cerebral angiogram or MRI scan to assess its status.
Depending on circumstances, your doctors may continue to prescribe anticoagulant medications in the weeks and months after your surgery to prevent clotting in the parent artery. Typically, a pipeline procedure reshapes the artery and resolves the aneurysm with no further need for treatment. However, you may be advised to make long-term lifestyle changes to eliminate factors that contribute to artery disease, such as smoking, hypertension, lack of exercise and an unhealthy diet.
Pipeline embolization makes it possible to treat many kinds of cerebral aneurysms. If your doctors have determined that this procedure is right for you, knowing what to expect can make your pipeline embolization recovery go more smoothly at every stage.
