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Objective: To investigate the safety and effectiveness of the Pipeline Flex embolization device (PFED) in the treatment of large and wide-necked aneurysms in the inteal carotid artery (ICA).Methods: The clinical data of 78 cases of large and wide-necked aneurysms in the ICA treated with this Pipeline Flex embolization device in Shanghai Hospital of the Second Military Medical University and Southe Hospital of Southe Medical University from February 2017 to June 2018 were retrospectively analyzed.Results: A total of 66 cases were treated with a Pipeline Flex embolization device,10 with a pipeline flex embolization device,and 2 with a double tubride stent (10 patients were treated with a pipeline stent-assisted coil embolization in;and 2 patients were treated with two pipeline stents).The patients were followed up for 3 to 18 months (average,9.25 months).Among them,63 cases had complete occlusion of the neck of the aneurysm (Raymondl Class Ⅰ;MRS score 0;80.8％).Aneurysms recurred in 12 cases (Raymondl Class Ⅱ;MRS score 1;15.4％).Delayed ischemic complications were observed in 1 case (MRS score ＞2;0.13％).There was 1 case of poor release of stent and 1 case of stent stenosis (0.13％).Conclusion: The treatment of large,wide-necked aneurysms in the ICA with PFED has a high total occlusion rate and good prognosis was better than coil embolization,but the placement of PFED still has some neurological complications.