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Spontaneous delayed migration/shortening of the pipeline embolization device: report of 5 cases
N Chalouhi1, S I Tjoumakaris, L F Gonzalez
1Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
Abstract:
Five patients were found to have spontaneous delayed migration/shortening of their Pipeline Embolization Devices on follow-up angiography. The device migrated proximally in 4 patients and distally in 1 patient. One patient had a subarachnoid hemorrhage and died as a result of migration of the Pipeline Embolization Device, and another patient presented with complete MCA occlusion and was left severely disabled. Mismatch in arterial diameter between inflow and outflow vessels was a constant finding. Migration of the Pipeline Embolization Device was managed conservatively, with additional placement of the device, or with parent vessel occlusion. Obtaining complete expansion of the embolization device by using a longer device, increasing vessel coverage, using adjunctive aneurysm coiling, and avoiding dragging and stretching of the device are important preventive measures. Neurointerventionalists should be aware of this potentially fatal complication and take all necessary preventive measures.
Insights
Delayed migration of Pipeline Embolization Devices (PEDs) occurred in five patients, leading to severe complications including death and disability. Careful device selection and placement are crucial for preventing this serious adverse event.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- The Pipeline Embolization Device (PED) is utilized for treating complex intracranial aneurysms.
- Delayed device migration is a potential, yet underreported, complication.
- Understanding risk factors and preventive strategies is essential for patient safety.
Observation:
- Five patients experienced spontaneous delayed migration or shortening of their PEDs on follow-up angiography.
- Migration occurred proximally in four patients and distally in one.
- A constant finding was a mismatch in arterial diameter between inflow and outflow vessels.
Findings:
- One patient died from subarachnoid hemorrhage secondary to PED migration.
- Another patient suffered severe disability due to complete Middle Cerebral Artery (MCA) occlusion.
- Management strategies included conservative treatment, additional device placement, or parent vessel occlusion.
Implications:
- Neurointerventionalists must be aware of PED migration as a potentially fatal complication.
- Preventive measures include ensuring complete device expansion, using longer devices, increasing vessel coverage, adjunctive aneurysm coiling, and avoiding device manipulation.
- Meticulous technique and appropriate device selection are paramount to mitigate risks associated with PEDs.
