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Medtronic received a report that the patient had multiple intracranial aneurysms of the right internal carotid artery, including a large 10mm aneurysm at the posterior communicating artery segment and a small 4mm aneurysm at the ophthalmic artery segment.The operator planned to implant a pipeline for treatment.During the procedure to establish access, it was found that the microcatheter could not enter the lumen of the navien due to significant resistance.After replacing with a new one, it went through successfully.The marksman microcatheter was positioned, and a ped-450-30 was delivered to the distal end of the microcatheter.However, the stent could not be came out despite being able to be retrieved.Multiple attempts were made withincreased pushing force, but the problem persisted.Subsequently, possibly due to repeated forceful manipulation, the aneurysm suddenly ruptured during the procedure.The operator stated that the stent had a quality issue and would not be charged for it.The device was stuck (locked up) in the catheter/resistance in the catheter.The catheter was flushed continuously with heparanized saline.The pipeline became stuck in the distal section of the catheter during delivery.The physician released the load (slack) in the system in an attempt to resolve the issue; however this did not resolve the issue.There was no damage to the catheter or pushwire.Patient symptoms or complications associated with this event were blood vessel rupture and bleeding.The pipeline was used for an approved (on-label) indication.The device and any accessories were prepared as indicated in the ifu.The catheter was flushed as indicated in the ifu.The patient was undergoing surgery for treatment of a saccular, unruptured aneurysms on the right internal carotid artery: one at the posterior communicating artery segment and one at the ophthalmic artery segment with a max diameter of 10 mm anda 9 mm neck diameter.The landing zone was 2.5 mm distal and 4.7 mm proximal.The access vessel was the femoral artery with a diameter of 10 mm.It was noted the patient's vessel tortuosity was severe.Dual antiplatelet therapy (dapt) was administered, platelet reactivity units (pru) level was normal.The angiographic result post procedure that due to elevated intracranial pressure, the contrast agent could not go far.Ancillary devices include a navien 6f guide catheter, marksman microcatheter.Additional information was received reporting that the actions or interventions taken to resolve the ruptured aneurysm/bleeding included promptly filled spring coils, drilled holes for drainage, and relieved pressure.The procedure was completed with surgical intervention with drilling hole drainage and decompression.The cause of the resistance and rupture/bleed was unknown.It was unknown if the rupture/bleed was caused by or related to the resistance.
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Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
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