Srinivasan Visish M, Carlson Andrew P, Mokin Maxim, Cherian Jacob, Chen Stephen R, Puri Ajit, Kan Peter
Departments of 1 Neurosurgery and.
Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico.
Neurosurg Focus. 2017 Jun;42(6):E16. doi: 10.3171/2017.3.FOCUS1738.
OBJECTIVE The Pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, the PED has its own unique technical challenges, including the occurrence of device foreshortening or migration leading to prolapse into the aneurysm. The authors sought to determine the incidence of this phenomenon, the rescue strategies, and outcomes. METHODS Four institutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with PEDs. Patient and aneurysm data as well as angiographic imaging were reviewed for all cases involving device prolapse into the aneurysm. RESULTS A total of 413 intracranial aneurysms were treated with PEDs during the study period, by 5 neurointerventionalists. Large and giant aneurysms (≥ 2 cm) accounted for 32 of these aneurysms. Among these 32 PEDs, prolapse into the aneurysm occurred in 3 patients, with 1 of these PEDs successfully rescued and the other 2 left in situ. No patients suffered any severe complications. The 2 patients in whom the PEDs were left in situ remained on antiplatelet therapy. CONCLUSIONS The PED may foreshorten or migrate during or after deployment, leading to prolapse into the aneurysm. This phenomenon appears to be associated with large and giant aneurysms, vessel tortuosity, short landing zones, and use of balloon angioplasty. Future study and follow-up is needed to further evaluate this phenomenon, but some of the observations and techniques described in this paper may help to prevent or salvage prolapsed devices.
管道栓塞装置（PED）常用于治疗前循环动脉瘤，尤其是在颈内动脉虹吸部周围，总体效果良好。然而，PED有其独特的技术挑战，包括装置缩短或移位导致脱垂至动脉瘤内。作者试图确定这种现象的发生率、补救策略及结果。方法：回顾四个机构的神经血管介入手术数据库中接受PED治疗的颅内动脉瘤病例。对所有涉及装置脱垂至动脉瘤内的病例的患者和动脉瘤数据以及血管造影影像进行回顾。结果：在研究期间，5名神经介入医生共使用PED治疗了413例颅内动脉瘤。其中大型和巨大动脉瘤（≥2 cm）占32例。在这32枚PED中，有3例出现脱垂至动脉瘤内的情况，其中1枚PED成功补救，另外2枚留在原位。没有患者出现任何严重并发症。2例PED留在原位的患者继续接受抗血小板治疗。结论：PED在释放过程中或释放后可能会缩短或移位，导致脱垂至动脉瘤内。这种现象似乎与大型和巨大动脉瘤、血管迂曲、短着陆区以及球囊血管成形术的使用有关。需要进一步的研究和随访来进一步评估这种现象，但本文描述的一些观察结果和技术可能有助于预防或挽救脱垂的装置。
