Endovascular Repositioning of a Pipeline Embolization Device Dislocated from the Vertebral into the Basilar Artery Using a Stent-in-Stent Technique

Kerl, H; Al-Zghloul, Mansour; Groden, Christoph; Brockmann, Marc A.

doi:10.1007/s00062-011-0128-8

Cited by 11 publications

(9 citation statements)

References 24 publications

(19 reference statements)

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“…The authors described that, in both patients, the PEDs migrated up to 3.3 mm distally as early as 2 weeks after deployment, even with the use of the anchoring overlapping stent 23. Intracranial migration of a PED has previously been described in the literature and appears to be relatively infrequent 19 24 25. Cohen et al 26 compared the Silk stent and a PED in intracranial applications and observed frequent migration of the Silk stent and no cases of PED migration.…”

Section: Discussionmentioning

confidence: 96%

Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series

Brzezicki

Rivet

Reavey‐Cantwell

2015

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 96%

Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series

Brzezicki

Rivet

Reavey‐Cantwell

2015

J NeuroIntervent Surg

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“…Different techniques have been described to solve PED migration, including open surgery,7 snare assisted rescue,2 3 balloon anchoring for distal end herniation,8 or stent-in-stent techniques 4. While distal end PED migration allows more endovascular rescue options, a proximal end migration requires more complex maneuvers to regain distal access through the stent, such as the presented case 2–4.…”

Section: Discussionmentioning

confidence: 98%

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

Martínez‐Galdámez

Ortega-Quintanilla

Hermosín

et al. 2016

J NeuroIntervent Surg

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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.

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“…Proximal migration of PEDs has been described in cases of placement within both anterior and posterior circulations [48][49][50][51][52][53][54][55] . Spontaneous shortening of PEDs has also been described [56] .…”

Section: Discussionmentioning

confidence: 99%

Anchoring Pipeline Flow Diverter Construct in the Treatment of Traumatic Distal Cervical Carotid Artery Injury

Amuluru¹,

Al‐Mufti²,

Roth

et al. 2017

Intervent Neurol

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Background: Traumatic extracranial internal carotid artery (ICA) dissections are uncommon and can be difficult to treat. Thinning of adventitia and dilatation may occur following arterial dissection, thus resulting in a fusiform pseudoaneurysm, which can subsequently cause bleeding, expanding, or pulsatile hematoma. Currently, medical management with anticoagulation remains the first line of treatment and yields good outcomes in 75% of cases with a mortality rate of 3-4%. Endovascular intervention is indicated with failure of medical therapy, progressive enlargement of a traumatic pseudoaneurysm, acute flow-related infarcts due to vessel occlusion, or when anticoagulation is contraindicated due to risk of pseudoaneurysm rupture and hemorrhage. Recognized interventional treatments include parent artery occlusion with or without revascularization, endovascular coil embolization, and covered stenting. Summary: A wide variety of endovascular stents are available that are capable of opening a stenosed vessel while obliterating the associated false lumen and providing a scaffold for embolization of the pseudoaneurysm. The use of the Pipeline Embolization Device (PED) in the management of traumatic intracranial pseudoaneurysms has been described. However, there are few reports on the usage of the PED for treating traumatic extracranial ICA dissection and/ or pseudoaneurysms. However, a potential complication of the use of PED in the extracranial ICA is a hypothetical tendency to migrate in a mobile vessel. Thus, the risk of migration of the PED has encouraged practitioners to adopt strategies to limit this risk. Key Messages: We describe different techniques employed to anchor the flow-diverting construct within tortuous, mobile vessels.

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Endovascular Repositioning of a Pipeline Embolization Device Dislocated from the Vertebral into the Basilar Artery Using a Stent-in-Stent Technique

Abstract: Repositioning of a lost PED is feasible using a stent-in-stent technique. Principally, dislodgement force is higher using a larger PED, while in this case care has to be taken to avoid incidental extraction of the second PED out of the microcatheter.

Cited by 11 publications

References 24 publications

Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series

Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series

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

Anchoring Pipeline Flow Diverter Construct in the Treatment of Traumatic Distal Cervical Carotid Artery Injury

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