Medtronic received information that two pipeline vantages failed to open in the middle section.The patient was being treated for a unruptured right paraopthamic saccular aneurism.The max diameter was 6-7 mm and the neck diameter was 4-5 mm.The diastal landing zone was 3 mm and the proximal landing zone was 4.5 mm.Vessel tortuosity was sever.The proximal internal carotid artery (ica) was tortuous and there was a tonsillar loop.The siphon was also tortuous.The pipeline stent was flared in the m1 and dragged back into the ica.The stent was deployed around the carotid siphon and it did not open, slack was taken off the entire system and forward tension on the entire system was applied to encourage stent to open.This was not successful as the stent would not open even after 4-5 attempts.The stent was retrieved successfully and a shorter stent was selected.The stent was deployed in the same position, while it also did not open around the ophthalmic bend the doctors decided to deploy the device as it was very close to the point of no return.The stent opened as the phenom 27 was tracked through the stent.Balloon angioplasty was required to help the proximal end fully oppose the vessel wall at the dysplastic segment. the failure to open was in the middle.The pipeline was positioned in a bend.More than 50% of the pipeline had been deployed when it failed to open.The pipeline was resheathed more than 2 times. the physician mentioned the patient had developed a new visual blind spot post procedure.Additional devices: neuron max, navien 058, fg15150 guidewire, synchro 2.
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