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Case Reports
. 2019 Apr;25(2):182-186.
doi: 10.1177/1591019918809932. Epub 2018 Nov 4.

Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

Manoj Bohara  1   2 , Kosuke Teranishi  2 , Kenji Yatomi  2 , Takashi Fujii  1   2 , Takayuki Kitamura  2 , Munetaka Yamamoto  2 , Hidenori Oishi  1   2
Affiliations
Case Reports

Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

Manoj Bohara et al. Interv Neuroradiol. 2019 Apr.

Abstract

Background: Flow diversion with the Pipeline embolization device (PED) is a widely accepted treatment modality for aneurysm occlusion. Previous reports have shown no recanalization of aneurysms on long-term follow-up once total occlusion has been achieved.

Case description: We report on a 63-year-old male who had a large internal carotid artery cavernous segment aneurysm. Treatment with PED resulted in complete occlusion of the aneurysm. However, follow-up angiography at four years revealed recurrence of the aneurysm due to disconnection of the two PEDs placed in telescoping fashion.

Conclusion: Herein, we present the clinico-radiological features and discuss the possible mechanisms resulting in the recanalization of aneurysms treated with flow diversion.

Keywords: Aneurysm; Pipeline Embolization Device; flow diverter; recurrence.

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Figures

Figure 1.
Figure 1.
Initial treatment of the left internal carotid artery cavernous segment large aneurysm (a) with two telescoped Pipeline embolization devices, resulting in complete occlusion of the aneurysm (b).
Figure 2.
Figure 2.
Follow-up digital subtraction angiography (a) and cone-beam computed tomography (b) at three-year follow-up showing no recurrence of the aneurysm.
Figure 3.
Figure 3.
Follow-up digital subtraction angiography (a) and cone-beam computed tomography (b) four years after the initial treatment showing recanalization of the aneurysm due to disconnection of the two Pipeline embolization devices.
Figure 4.
Figure 4.
The measurement of the extent of overlap of the two Pipeline embolization devices showing that the length of overlap after the initial treatment was 11.57 mm (a) whereas that at three-year follow-up was reduced to 1.15 mm (b).
Figure 5.
Figure 5.
Retreatment with addition of a Pipeline embolization device (PED, indicated by black arrow) to connect the detached PEDs ((a), cone-beam computed tomography), resulting in complete occlusion of the aneurysm after one month ((b), digital subtraction angiography).
See this image and copyright information in PMC

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