Republished: Novel balloon application for rescue and realignment of a proximal end migrated pipeline flex embolization device into the aneurysmal sac: complication management

Abstract

The pipeline embolization device (PED) has become a routine firstline option for the treatment of an increasing population of intracranial aneurysms at many neurovascular centers. Intraprocedural complications during PED deployment, or complications associated with migration of the device, are rarely reported problems. Significant mismatch in luminal diameter between the inflow vessel and the outflow vessel or excessive dragging-stretching of the PED have been related to 'watermelon seed' or 'accordion' effects, respectively, resulting in stent migration. Here we present a novel balloon technique that was successfully used to realign an in situ flow diverting stent that had prolapsed into a large aneurysm. This represents a useful salvage technique and should be considered when encountering this potential complication.

Periprocedural outcomes and early safety with the use of the Pipeline Flex Embolization Device with Shield Technology for unruptured intracranial aneurysms: preliminary results from a prospective clinical study

“… 1 2 The Pipeline Embolization Device (PED; Medtronic Neurovascular, Irvine, California, USA) has become a routine first-line treatment option for an increasing patient population with IAs. 1 3 The first-generation PED device, used for the embolization of cerebral aneurysms, received European CE mark approval in 2008 and US FDA approval in 2011. 4 Its safety and efficacy have been demonstrated in numerous clinical studies, such as the Pipeline for Uncoilable and Failed Aneurysms (PUFS) trial, 5 the International Retrospective Study of PED (IntrePED), 6 the Aneurysm Study of Pipeline in an Observational Registry (ASPIRe) study, 7 and several large clinical series.…”

Tied Pipeline: A Case of Rare Complication

“…In this situation, a Hyperform TM balloon was useful for moving the stent and changing its direction. 6) The over-length stent might also induce this situation. On planning the telescoping stents, we tend to select the longest stent to save the number of stents.…”

Internal Carotid Artery Reconstruction with a “Mega Flow Diverter”: First Experience with the 6×50 mm DERIVO Embolization Device

“…Poor wall-apposition has been described as a predictive factor for immediate instent and delayed thrombosis after stents use [ 6 ]. In this sense, precise measurement and device selection are mandatory steps when considering flow diverter usage in order to avoid potential complications [ 7 , 8 ].…”