Multiple pipeline twists encountered during treatment of a symptomatic fusiform ICA aneurysm

Robert W. Young, Matthew T. Bender, Geoffrey P. Colby, Alexander Coon

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article numbere230036
JournalBMJ case reports
Volume12
Issue number7
DOIs
StatePublished - Jul 1 2019

Keywords

  • interventional radiology
  • neurosurgery
  • stroke

ASJC Scopus subject areas

  • Medicine(all)

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