Endovascular Rescue Strategies for Nonopening of Pipeline Device: Report of Two Cases
| العنوان: | Endovascular Rescue Strategies for Nonopening of Pipeline Device: Report of Two Cases |
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| المؤلفون: | Anshu Mahajan, Apratim Chatterjee, Vinit Banga, Gaurav Goel |
| المصدر: | Asian Journal of Neurosurgery |
| بيانات النشر: | Wolters Kluwer - Medknow, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | medicine.medical_specialty, medicine.medical_treatment, Case Report, internal carotid artery, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, medicine.artery, medicine, Transcranial approach, Embolization, intra-Navien deployment, Pipeline Flex embolization device, business.industry, Pipeline device, flow diverter, General Medicine, medicine.disease, Pipeline (software), Surgery, Anterior communicating artery, Catheter, Cavernous sinus, cardiovascular system, Internal carotid artery, business, 030217 neurology & neurosurgery |
| الوصف: | 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. |
| اللغة: | English |
| تدمد: | 2248-9614 1793-5482 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c7d05f5e2d3fa4cf5055a84e4a570da6 http://europepmc.org/articles/PMC6896616 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....c7d05f5e2d3fa4cf5055a84e4a570da6 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 22489614 17935482 |
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