A case of pipeline migration in the cervical carotid

Since its emergence in 2011, the pipeline flow diversion (PFD) has gained recognition in the treatment of certain intracranial aneurysms. However, early or delayed pipeline migration (PM) and micro-catheter/guidewire retention have been infrequently reported. We report a case of PM and shortening in the treatment of a left cervical internal carotid artery (LICA) aneurysm. A middle-aged African-American patient presents for an off-label PFD treatment of an incidental 21 × 23 mm aneurysm at the sub-petrous segment of the left ICA. While the patient remained completely neuro-intact, a 6 months follow-up angiogram revealed a persisting filling of the cervical aneurysm with a foreshortening of the pipeline by 1/3 of its original 30 mm size and proximal migration into the aneurysmal sac. We opted to watch the aneurysm within 6 months especially that the aneurysm was extra-cranial and because of the potential risks involved in trying to re-access the device.