Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
J Stroke Cerebrovasc Dis. 2020 Apr;29(4):104647. doi: 10.1016/j.jstrokecerebrovasdis.2020.104647. Epub 2020 Jan 31.
Flow diverters have revolutionized the treatment of large aneurysms. However, prolapse of the device into the aneurysm is a known complication that may have fatal consequences.
We present a case of a 21-year-old male with a giant aneurysm located in the cavernous segment of the right internal carotid artery. After Pipeline Embolization Device (PED) deployment, while retrieving the PED wire, the proximal end of the stent shortened, resulting in prolapse of the device into the aneurysm. We utilized the Pull on Pipe (POP) maneuver, characterized by the deployment of a second PED inside the lumen of the prolapsed device and gentle traction to restore the initial flow diverter into its proper position. The maneuver also allows for the immediate deployment of the second PED to improve proximal purchase and overall construct stability.
The POP maneuver is a novel strategy for salvaging herniated flow diverters and establishing a more stable PED construct.
血流导向装置的出现彻底改变了大型动脉瘤的治疗方式。然而，器械突入动脉瘤是一种已知的并发症，可能会导致致命的后果。
我们报告了一例 21 岁男性患者，其右侧颈内动脉海绵窦段存在巨大动脉瘤。在使用 Pipeline 栓塞装置（PED）进行治疗后，在取出 PED 导丝时，支架的近端缩短，导致器械突入动脉瘤。我们采用了 Pull on Pipe（POP）操作，即在突入的器械管腔内部署第二个 PED，并轻轻牵拉，使最初的血流导向装置恢复到适当的位置。该操作还可以立即部署第二个 PED，以改善近端的固定并提高整体器械的稳定性。
POP 操作是一种新颖的策略，可用于抢救突入的血流导向装置，并建立更稳定的 PED 结构。
