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CASE REPORT
Multiple pipeline twists encountered during treatment of a symptomatic fusiform ICA aneurysm
  1. Robert W Young1,
  2. Matthew T Bender1,
  3. Geoffrey P Colby2 and
  4. Alexander L Coon1
  1. 1 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
  1. Correspondence to Alexander L Coon, acoon2{at}jhmi.edu

Abstract

Pipeline embolisation device (PED) ‘twisting’ is an intra-operative complication that manifests with the appearance of a ‘figure-8’ in perpendicular planes on digital subtraction angiography. A twisted PED causes narrowing and/or complete occlusion of the vessel lumen and poses significant risks for thrombus formation and downstream ischaemia. Here, we present a case in which three unique PED implants become twisted during pipeline embolisation of a large fusiform internal carotid artery aneurysm. The twists were remediated by balloon angioplasty and a combination of techniques that allowed the PED to rotate and restore its original axis. Six-month and twelve-month follow-up angiography demonstrated complete aneurysm occlusion with preservation of the parent vessel, proving that proper remediation of PED twisting can still result in successful long-term outcomes.

  • interventional radiology
  • neurosurgery
  • stroke
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Footnotes

  • Contributors RWY drafted and revised the paper and contributed to image collection. MTB revised the paper and contributed to image collection. GPC revised the paper. ALC proposed the idea, revised the paper and contributed to image collection. He is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ALC reports personal fees and non-financial support from Medtronic, personal fees and non-financial support from MicroVention, personal fees and non-financial support from Stryker Neurovascular, outside the submitted work. GPC reports personal fees and non-financial support from Medtronic, personal fees and non-financial support from MicroVention, outside the submitted work. MTB has nothing to disclose. RWY has nothing to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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