Letter to the Editor: Surgical bailout of giant supraclinoid ICA aneurysm following treatment with Pipeline Embolization Device

Brasiliense, Leonardo B.C.; Navarro, Ramón; Brazis, Paul W.; Tawk, Rabih G.

doi:10.3171/2014.9.peds14456

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…1,3 Microsurgery involving PED-treated vessels, even if not addressing the PED directly, can be quite difficult. 4,10,12 In Case 1, this was declined by the patient; in Case 2, the patient had already failed a BTO and ipsilateral extracranial-intracranial bypass, so sacrifice was not an option. To have this salvage strategy as an option, it is important to assess collateral circulation and to perform a BTO prior to treatment of these very large and giant aneurysms.…”

Section: Sacrifice/bypassmentioning

confidence: 99%

Prolapse of the Pipeline embolization device in aneurysms: incidence, management, and outcomes

Srinivasan¹,

Carlson

Mokin

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe Pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, the PED has its own unique technical challenges, including the occurrence of device foreshortening or migration leading to prolapse into the aneurysm. The authors sought to determine the incidence of this phenomenon, the rescue strategies, and outcomes.METHODSFour institutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with PEDs. Patient and aneurysm data as well as angiographic imaging were reviewed for all cases involving device prolapse into the aneurysm.RESULTSA total of 413 intracranial aneurysms were treated with PEDs during the study period, by 5 neurointerventionalists. Large and giant aneurysms (≥ 2 cm) accounted for 32 of these aneurysms. Among these 32 PEDs, prolapse into the aneurysm occurred in 3 patients, with 1 of these PEDs successfully rescued and the other 2 left in situ. No patients suffered any severe complications. The 2 patients in whom the PEDs were left in situ remained on antiplatelet therapy.CONCLUSIONSThe PED may foreshorten or migrate during or after deployment, leading to prolapse into the aneurysm. This phenomenon appears to be associated with large and giant aneurysms, vessel tortuosity, short landing zones, and use of balloon angioplasty. Future study and follow-up is needed to further evaluate this phenomenon, but some of the observations and techniques described in this paper may help to prevent or salvage prolapsed devices.

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