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Twenty-one patients with previously stented recurrent aneurysms who later underwent Pipeline Embolization Device placement (group 1) were retrospectively identified and compared with 63 patients who had treatment with the Pipeline with no prior stent placement (group 2). Pipeline treatment resulted in complete aneurysm occlusion in 55.6% of patients in group 1 versus 80.4% of patients in group 2. The retreatment rate in group 1 was 11.1% versus 7.1% in group 2. The authors conclude that the Pipeline is less effective in the management of previously stented aneurysms than when used in nonstented aneurysms.