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

Robert W C YoungMatthew T BenderGeoffrey P ColbyAlexander L Coon
Published in: BMJ case reports (2019)
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.
Keyphrases
  • internal carotid artery
  • coronary artery
  • optical coherence tomography
  • computed tomography
  • abdominal aortic aneurysm
  • middle cerebral artery
  • magnetic resonance imaging
  • ultrasound guided