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Endovascular Rescue Strategies for Nonopening of Pipeline Device: Report of Two Cases

We report two cases of rescue strategies for nonopening of Pipeline flow-diverter device for the treatment of intracranial aneurysm. The first patient, a 65-year-old female, presented with complaints of headache for 3 months and was found to have giant supraclinoid internal carotid artery (ICA) (oph...

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Autores principales: Mahajan, Anshu, Banga, Vinit, Chatterjee, Apratim, Goel, Gaurav
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896616/
https://www.ncbi.nlm.nih.gov/pubmed/31903371
http://dx.doi.org/10.4103/ajns.AJNS_191_19
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author Mahajan, Anshu
Banga, Vinit
Chatterjee, Apratim
Goel, Gaurav
author_facet Mahajan, Anshu
Banga, Vinit
Chatterjee, Apratim
Goel, Gaurav
author_sort Mahajan, Anshu
collection PubMed
description We report two cases of rescue strategies for nonopening of Pipeline flow-diverter device for the treatment of intracranial aneurysm. The first patient, a 65-year-old female, presented with complaints of headache for 3 months and was found to have giant supraclinoid internal carotid artery (ICA) (ophthalmic segment) aneurysm. We planned endovascular partial coiling and flow-diverter placement for the treatment of ICA aneurysm. During the progressive deployment of PED, there was nonopening of Pipeline embolization device (PED) at its proximal end. We tried multiple attempts to navigate Marksman microcatheter over the PED delivery microwire and Echelon microcatheter over the Traxcess microwire across the pinched site, but we were not able to achieve success. After that, we tried opposite transcranial approach across prominent anterior communicating artery with the Synchro and Transcend microguidewire which finally resulted in the opening of the device; however, there was acute extravasation of dye on check angiogram. Thus, our technical success turned into disaster. The second patient, a 55-year-old female, presented with complaint of seizures for 3 months due to mass effect of cavernous sinus aneurysm. Pipeline Flex flow-diverter placement was done across the aneurysm neck. During the progressive deployment of device, there was nonopening of the mid and proximal segment of Pipeline Flex which was successfully managed by intra-Navien deployment of device followed by simultaneous push of Marksman microcatheter and pull of Navien catheter. In our case series, two rescue strategies were applied to successfully open the proximal constricted portion of Pipeline Flex; however, technical success in one case resulted in unmanageable disasters. Thus, transcranial rescue strategy for opening the constricted Pipeline Flex device should be cautiously used in our endovascular practice.
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spelling pubmed-68966162020-01-03 Endovascular Rescue Strategies for Nonopening of Pipeline Device: Report of Two Cases Mahajan, Anshu Banga, Vinit Chatterjee, Apratim Goel, Gaurav Asian J Neurosurg Case Report We report two cases of rescue strategies for nonopening of Pipeline flow-diverter device for the treatment of intracranial aneurysm. The first patient, a 65-year-old female, presented with complaints of headache for 3 months and was found to have giant supraclinoid internal carotid artery (ICA) (ophthalmic segment) aneurysm. We planned endovascular partial coiling and flow-diverter placement for the treatment of ICA aneurysm. During the progressive deployment of PED, there was nonopening of Pipeline embolization device (PED) at its proximal end. We tried multiple attempts to navigate Marksman microcatheter over the PED delivery microwire and Echelon microcatheter over the Traxcess microwire across the pinched site, but we were not able to achieve success. After that, we tried opposite transcranial approach across prominent anterior communicating artery with the Synchro and Transcend microguidewire which finally resulted in the opening of the device; however, there was acute extravasation of dye on check angiogram. Thus, our technical success turned into disaster. The second patient, a 55-year-old female, presented with complaint of seizures for 3 months due to mass effect of cavernous sinus aneurysm. Pipeline Flex flow-diverter placement was done across the aneurysm neck. During the progressive deployment of device, there was nonopening of the mid and proximal segment of Pipeline Flex which was successfully managed by intra-Navien deployment of device followed by simultaneous push of Marksman microcatheter and pull of Navien catheter. In our case series, two rescue strategies were applied to successfully open the proximal constricted portion of Pipeline Flex; however, technical success in one case resulted in unmanageable disasters. Thus, transcranial rescue strategy for opening the constricted Pipeline Flex device should be cautiously used in our endovascular practice. Wolters Kluwer - Medknow 2019-11-25 /pmc/articles/PMC6896616/ /pubmed/31903371 http://dx.doi.org/10.4103/ajns.AJNS_191_19 Text en Copyright: © 2019 Asian Journal of Neurosurgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Case Report
Mahajan, Anshu
Banga, Vinit
Chatterjee, Apratim
Goel, Gaurav
Endovascular Rescue Strategies for Nonopening of Pipeline Device: Report of Two Cases
title Endovascular Rescue Strategies for Nonopening of Pipeline Device: Report of Two Cases
title_full Endovascular Rescue Strategies for Nonopening of Pipeline Device: Report of Two Cases
title_fullStr Endovascular Rescue Strategies for Nonopening of Pipeline Device: Report of Two Cases
title_full_unstemmed Endovascular Rescue Strategies for Nonopening of Pipeline Device: Report of Two Cases
title_short Endovascular Rescue Strategies for Nonopening of Pipeline Device: Report of Two Cases
title_sort endovascular rescue strategies for nonopening of pipeline device: report of two cases
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896616/
https://www.ncbi.nlm.nih.gov/pubmed/31903371
http://dx.doi.org/10.4103/ajns.AJNS_191_19
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