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Retrieval of distorted pipeline embolic device using snare-loop.

Bartley Mitchell1, Liang-Der Jou2, Michel Mawad3

  • 1Department of Neurosurgery, Baylor College of Medicine, 1709 Dryden, Suite 750, Houston, TX 77030, USA.

Journal of Vascular and Interventional Neurology
|January 8, 2015
PubMed
Summary

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Malpositioned flow-diverter stents, like the Pipeline Embolic Device (PED), can be safely removed using endovascular snare-loops. This allows for successful retreatment of intracranial aneurysms, preventing potential complications.

Area of Science:

  • Endovascular neurosurgery
  • Interventional neuroradiology
  • Medical device technology

Background:

  • Flow-diverter stents are increasingly utilized for intracranial aneurysm treatment.
  • Increased use may lead to higher rates of stent malpositioning, distortion, or migration.
  • Complications from malpositioned stents pose risks for iatrogenic stroke.

Purpose of the Study:

  • To describe the successful endovascular removal of a deformed Pipeline Embolic Device (PED) stent.
  • To highlight the utility of snare-loop devices for retrieving malpositioned endovascular devices.
  • To emphasize the importance of contingency planning in stent-based aneurysm treatment.

Main Methods:

  • A case report detailing the conformational twisting and deformity of a PED stent during carotid artery placement.
Keywords:
IntracranialPipeline embolic deviceaneurysmretrievalsnare loop

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  • Description of immediate stent retrieval using an endovascular snare-loop.
  • Subsequent successful treatment of the aneurysm with a second PED stent after removal of the deformed device.

    • Main Results:

    • The malformed PED stent was successfully removed using a snare-loop device.
    • The intracranial aneurysm was subsequently treated effectively with a second PED stent.
    • Demonstrates the feasibility and safety of endovascular retrieval for deformed flow-diverter stents.

    Conclusions:

    • Endovascular snare-loop devices are effective for removing malpositioned or deformed flow-diverter stents.
    • Having a retrieval strategy is critical for managing complications associated with stent placement.
    • Prompt removal of problematic stents can mitigate the risk of iatrogenic stroke and allow for successful aneurysm treatment.