The POP (Pull on Pipe) Maneuver: A Technical Note for Rescuing a Prolapsed Pipeline Device

J Stroke Cerebrovasc Dis. 2020 Apr;29(4):104647. doi: 10.1016/j.jstrokecerebrovasdis.2020.104647. Epub 2020 Jan 31.

Abstract

Background: 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.

Case: 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.

Conclusion: The POP maneuver is a novel strategy for salvaging herniated flow diverters and establishing a more stable PED construct.

Keywords: Endovascular; aneurysm; flow diversion; pipeline; prolapse.

Publication types

  • Case Reports

MeSH terms

  • Carotid Artery, Internal* / diagnostic imaging
  • Carotid Artery, Internal* / physiopathology
  • Cerebrovascular Circulation*
  • Device Removal*
  • Endovascular Procedures / adverse effects*
  • Endovascular Procedures / instrumentation*
  • Foreign-Body Migration / diagnostic imaging
  • Foreign-Body Migration / etiology
  • Foreign-Body Migration / therapy*
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / physiopathology
  • Intracranial Aneurysm / therapy*
  • Male
  • Stents*
  • Treatment Outcome
  • Young Adult