In situ removal of the pipeline embolization device: the 'corking' and 'pseudo-corking' techniques

The pipeline embolization device (PED) is a revolutionary tool for the endovascular treatment of intracranial aneurysms by flow diversion. Treatment using the PED often requires considerable manipulation and customization by the neurointerventionalist at the time of deployment. Proper use of the PED involves a novel set of techniques and associated jargon, which must be learned by all neurointerventionalists, fellows and residents for safe treatment of patients with this device. In this report, the PED removal techniques referred to as 'corking' and 'pseudo-corking' are described. Corking is used for the removal of a partially deployed in situ PED when the pusher wire is intact whereas 'pseudo-corking' is used if the pusher wire is fractured or disconnected. Knowledge of both techniques is necessary for withdrawing the PED in situations of malposition or failed expansion.