6.1 The committee concluded that current evidence supports the case for adoption of Pipeline when it is used in highly selected patients with complex giant or large intracranial aneurysms which are unsuitable for surgery and being considered for stenting, when the number of Pipeline embolisation devices does not exceed 2 and when 32 or more coils and 1 stent would be needed during stent-assisted coiling. For these patients use of Pipeline appears efficacious and is less costly than stent-assisted coiling.
6.2 The committee noted that standard management of intracranial aneurysms varies according to the size and type of aneurysm and the symptoms the patient experiences. This may include conservative management, for example, in patients whose complex giant or large intracranial aneurysms are unsuitable in size or shape for stent-assisted coiling or surgery, and for whom parent vessel occlusion would result in stroke or death. The recommendations in section 1 of the guidance are based on circumstances in which Pipeline releases resources, and were not framed on the basis of treating patients for whom there is no other viable option apart from conservative management. The committee saw little evidence in this patient group and this area of unmet clinical need would benefit from further research.