Martínez-galdámez, m., ortega-quintanilla, j., hermosín, a., crespo-vallejo, e., ailagas, j.J., <(>&<)> pérez, s.(2017).Novel bal loon application for rescue and realignment of a proximal end migrated pipeline flex embolization device into the aneurysmal sac: complication management.J neurointervent surg.Doi:10.1136/bcr-2016-012263.Rep the pipeline flex device will not be returned for evaluation as it remains implanted in the patient.From the information provided in the article, the event was likely due to mismatch between the inflow and outflow vessel size.Per the article, the pipeline braid was "slightly oversized" in the distal ica.The pipeline flex ifu states, "use of implants with labeled diameter larger than the parent vessel diameter may result in decreased effectiveness and additional safety risk due to incomplete foreshortening resulting in an implant longer than anticipated." if information is provided in the future, a supplemental report will be issued.
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Medtronic literature review found a report of intraprocedural pipeline flex foreshortening and prolapse into the aneurysm.The patient had presented with dizziness and fatigue.Mr angiography and subsequent ct angiography demonstrated a wide neck, 14 mm left supraclinoid internal carotid artery (ica) aneurysm.Endovascular treatment with a flow diverter was recommended.The article states that during the procedure, a guide catheter was navigated into the left internal carotid artery (ica) through a guiding sheath; a microcatheter was advanced into the left middle cerebral artery (mca) trunk.Due to the short landing zone of the distal ica above the aneurysm neck, the distal end of the pipeline flex 4 x 18 mm was deployed in the mca.The article notes that the device diameter was chosen according to the diameter of the larger proximal parent artery knowing the device would be slightly oversized in the distal ica.Following pipeline flex deployment and microcatheter withdrawal, the proximal aspect of the pipeline flex foreshortened and prolapsed into the aneurysm.The article states that multiple attempts (using a variety of microwires and microcatheter shapes) were made to regain access across the pipeline flex; all attempts were unsuccessful.It was noted that vessel tortuosity (two sharp 90° turns proximal to the aneurysm) made access difficult.Finally, the decision was made to modify the location of the proximal end ped from the inflow to the outflow portion using a balloon technique.The physician advanced a balloon catheter to the aneurysm and managed to use the balloon to realign the pipelineflex with the aneurysm neck.Two additional telescoping pipeline flex devices were placed to cover the aneurysm neck and complete the procedure.The patient had an uneventful postoperative course and was discharged home three days later.
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