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Delayed migration of a pipeline embolization device.

Nohra Chalouhi¹, Sudhakar R Satti, Stavropoula Tjoumakaris

¹Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA 19107, USA.

|November 30, 2012

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Delayed migration of the Pipeline Embolization Device (PED) can occur in patients with complex aneurysms. This case highlights the importance of accurate sizing and early follow-up to prevent and manage this complication.

Area of Science:

Neuroendovascular surgery
Cerebrovascular disease management
Medical device technology

Background:

Giant and complex aneurysms are increasingly treated with the Pipeline Embolization Device (PED).
Clinical experience with PEDs is still developing.
The Pipeline Embolization Device (PED) is used for treating brain aneurysms.

Observation:

A patient with a large cavernous internal carotid artery aneurysm treated with a PED experienced symptom recurrence 5 months post-procedure.
Routine 6-month follow-up angiography revealed proximal migration of the PED, with the device end projecting into the aneurysm sac.
The migrated PED showed significant foreshortening, exceeding 1 cm in migration distance.

Findings:

A second, overlapping PED was successfully deployed to cover the aneurysm neck and redirect flow.

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Complete resolution of the patient's symptoms was achieved 4 weeks after the second procedure.

This case represents the first reported instance of delayed intracranial PED migration.

Implications:

Delayed proximal migration is a potential complication following PED placement.
Precise stent sizing and ensuring adequate apposition to the vessel wall may reduce migration risk.
Early imaging follow-up is recommended if there are concerns about PED position.