Abstract
Background: Flow diverters have revolutionized the treatment of large aneurysms. However, prolapse
of the device into the aneurysm is a known complication that may have fatal consequences.
Case: We present a case of a 21-year-old male with a giant aneurysm located in the cavernous
segment of the right internal carotid artery. After Pipeline Embolization Device (PED)
deployment, while retrieving the PED wire, the proximal end of the stent shortened,
resulting in prolapse of the device into the aneurysm. We utilized the Pull on Pipe
(POP) maneuver, characterized by the deployment of a second PED inside the lumen of
the prolapsed device and gentle traction to restore the initial flow diverter into
its proper position. The maneuver also allows for the immediate deployment of the
second PED to improve proximal purchase and overall construct stability. Conclusion: The POP maneuver is a novel strategy for salvaging herniated flow diverters and establishing
a more stable PED construct.
Key Words
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References
- Pipeline for Uncoilable or failed aneurysms: results from a multicenter clinical trial.Radiology. 2013; 267: 858-868https://doi.org/10.1148/radiol.13120099
- Endovascular coiling versus parent artery occlusion for treatment of cavernous carotid aneurysms: a meta-analysis.J Neurointerv Surg. 2015; 7: 250-255https://doi.org/10.1136/neurintsurg-2014-011102
- Therapeutic internal carotid artery occlusion for large and giant aneurysms: a single center cohort of 146 patients.Am J Neuroradiol. 2016; 37: 125-129https://doi.org/10.3174/ajnr.A4487
- A new endoluminal, flow-disrupting device for treatment of saccular aneurysms.Stroke. 2007; 38: 2346-2352https://doi.org/10.1161/STROKEAHA.106.479576
- Safety and efficacy of the Pipeline embolization device for treatment of intracranial aneurysms: a pooled analysis of 3 large studies.J Neurosurg. 2017; 127: 775-780https://doi.org/10.3171/2016.8.JNS16467
- Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms.J Neurointerv Surg. 2009; 1: 56-65https://doi.org/10.1136/jnis.2009.000083
- Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis.Neurosurg Focus. 2017; 42: E17https://doi.org/10.3171/2017.3.FOCUS16450
- Prolapse of the Pipeline embolization device in aneurysms: incidence, management, and outcomes.Neurosurg Focus. 2017; 42: E16https://doi.org/10.3171/2017.3.FOCUS1738
- Spontaneous delayed migration/shortening of the pipeline embolization device: report of 5 cases.Am J Neuroradiol. 2013; 34: 2326-2330https://doi.org/10.3174/ajnr.A3632
- Fatal outcome after delayed pipeline embolization device migration for the treatment of a giant superior cerebellar artery aneurysm: technical note for complication avoidance.Open J Mod Neurosurg. 2014; 04: 163-168https://doi.org/10.4236/ojmn.2014.44028
- Retrograde trans-posterior communicating artery snare-assisted rescue of lost access to a foreshortened pipeline embolization device: complication management.Oper Neurosurg. 2010; 67: ons495-ons502https://doi.org/10.1227/NEU.0b013e3181f8530d
- Rescue microsurgery with bypass and stent removal following Pipeline treatment of a giant internal carotid artery terminus aneurysm.Acta Neurochir (Wien). 2015; 157: 2071-2075https://doi.org/10.1007/s00701-015-2593-3
- Novel application of a balloon-anchoring technique for the realignment of a prolapsed Pipeline Embolization Device: a technical report.J Neurointerv Surg. 2014; 6: 439-444https://doi.org/10.1136/neurintsurg-2013-010806
- Novel balloon application for rescue and realignment of a proximal end migrated pipeline flex embolization device into the aneurysmal sac: complication management.BMJ Case Rep. 2016; (bcr2016012263)https://doi.org/10.1136/bcr-2016-012263
- Techniques in distal access of wide-necked giant intracranial aneurysms during treatment with flow diversion.Surg Neurol Int. 2015; 6: 284https://doi.org/10.4103/2152-7806.157797
Article info
Publication history
Published online: January 30, 2020
Accepted:
January 1,
2020
Received in revised form:
December 15,
2019
Received:
November 13,
2019
Footnotes
Funding: This study did not receive any financial support.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104647
Copyright
© 2020 Elsevier Inc. All rights reserved.
