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Research ArticleInterventional

Spontaneous Delayed Migration/Shortening of the Pipeline Embolization Device: Report of 5 Cases

N. Chalouhi, S.I. Tjoumakaris, L.F. Gonzalez, D. Hasan, P.J. Pema, G. Gould, R.H. Rosenwasser and P.M. Jabbour
American Journal of Neuroradiology December 2013, 34 (12) 2326-2330; DOI: https://doi.org/10.3174/ajnr.A3632
N. Chalouhi
aFrom the Department of Neurosurgery (N.C., S.I.T., L.F.G., G.G., R.H.R., P.M.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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S.I. Tjoumakaris
aFrom the Department of Neurosurgery (N.C., S.I.T., L.F.G., G.G., R.H.R., P.M.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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L.F. Gonzalez
aFrom the Department of Neurosurgery (N.C., S.I.T., L.F.G., G.G., R.H.R., P.M.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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D. Hasan
bDepartment of Neurosurgery (D.H.), University of Iowa, Iowa City, Iowa
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P.J. Pema
cDepartment of Radiology (P.J.P.), Riverside Methodist Hospital, Columbus, Ohio.
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G. Gould
aFrom the Department of Neurosurgery (N.C., S.I.T., L.F.G., G.G., R.H.R., P.M.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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R.H. Rosenwasser
aFrom the Department of Neurosurgery (N.C., S.I.T., L.F.G., G.G., R.H.R., P.M.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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P.M. Jabbour
aFrom the Department of Neurosurgery (N.C., S.I.T., L.F.G., G.G., R.H.R., P.M.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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  • Fig 1.
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    Fig 1.

    A, Angiogram after deployment of a PED extending from the proximal superior division of the M2 segment to the mid-M1 segment. B, Angiogram showing complete MCA occlusion 5 months later with distal PED migration.

  • Fig 2.
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    Fig 2.

    A, Angiogram showing a PED that was deployed from the mid-M1 segment to the proximal cavernous ICA. B, DSA showing proximal PED migration. Note the new rupture site on the aneurysmal dome facing the displaced PED. C, Noncontrast head CT scan on postoperative day 3 showing an extensive subarachnoid hemorrhage, with displacement of the distal limb of the device now located centrally within the aneurysmal sac.

  • Fig 3.
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    Fig 3.

    A, A PED is deployed across 2 aneurysms extending from the petrous segment to the paraclinoid segment of the ICA. B, Follow-up angiography 4 months later showing that the distal portion of the PED had migrated slightly proximally, with the neck of the SHA aneurysm no longer covered by the device.

  • Fig 4.
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    Fig 4.

    A, Angiogram showing the initial position of the PED; the distal end is at the clinoid segment. B, Angiogram showing proximal migration of the PED; the distal end of the device is now within the aneurysmal sac.

Tables

  • Figures
  • PED migration characteristics

    Patient No.Length of PED Extending to Aneurysm (mm)Migration Distance (mm)Migration of Proximal or Distal End of PED?
    Proximal to AneurysmDistal to Aneurysm
    1769Proximal
    2101520Distal
    31535Distal
    4107>10Distal and proximal
    5133.57.5Distal
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American Journal of Neuroradiology: 34 (12)
American Journal of Neuroradiology
Vol. 34, Issue 12
1 Dec 2013
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Cite this article
N. Chalouhi, S.I. Tjoumakaris, L.F. Gonzalez, D. Hasan, P.J. Pema, G. Gould, R.H. Rosenwasser, P.M. Jabbour
Spontaneous Delayed Migration/Shortening of the Pipeline Embolization Device: Report of 5 Cases
American Journal of Neuroradiology Dec 2013, 34 (12) 2326-2330; DOI: 10.3174/ajnr.A3632

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Spontaneous Delayed Migration/Shortening of the Pipeline Embolization Device: Report of 5 Cases
N. Chalouhi, S.I. Tjoumakaris, L.F. Gonzalez, D. Hasan, P.J. Pema, G. Gould, R.H. Rosenwasser, P.M. Jabbour
American Journal of Neuroradiology Dec 2013, 34 (12) 2326-2330; DOI: 10.3174/ajnr.A3632
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