title: Delayed migration of a pipeline embolization device.
abstract: BACKGROUND
  Giant and complex aneurysms are increasingly treated with the Pipeline Embolization Device (PED). However, clinical experience with the device remains preliminary.
  
  
  OBJECTIVE
  To report the first case of a delayed migration of an intracranial PED.
  
  
  METHODS
  A 61-year-old woman with a known large right cavernous internal carotid artery aneurysm had a 3-month history of increasing retro-orbital pain. She underwent uneventful treatment of her aneurysm with the PED.
  
  
  RESULTS
  Five months after the procedure, the patient's pain recurred. On the routine 6-month follow-up angiography, there was proximal PED migration, with the distal end of the device projecting directly into the aneurysm and creating a jet of contrast against the aneurysm sac. The migration distance was more than 1 cm, and there was significant foreshortening of the device. A second, overlapping PED was successfully deployed within the first PED to bridge the neck of the aneurysm and redirect the flow jet away from the aneurysm sac. Complete resolution of the patient's symptoms was noted 4 weeks later.
  
  
  CONCLUSIONS
  Delayed proximal migration may occur after placement of a PED. Accurate stent sizing and adequate apposition to the vessel wall may minimize the occurrence of this undesirable phenomenon. If there is any concern regarding the position of the PED, early imaging follow-up may be indicated.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA 19107, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Sudhakar R
authors.initials: SR
authors.lastname: Satti
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D011475:Prosthesis Failure / Q000009:adverse effects*; D011859:Radiography; D012086:Reoperation; D015607:Stents / Q000009:adverse effects