title: Retrieval of distorted pipeline embolic device using snare-loop.
abstract: BACKGROUND
  Flow-diverter stents are increasingly being used in the endovascular treatment of intracranial aneurysms. Because of this increased usage, the occurrence of stent malpositioning, intra-arterial distortion, or migration will likely increase as well.
  
  
  METHODS
  We describe the conformational twisting and deformity of a pipeline embolic device (PED) stent (Covidien, EV3) within the carotid artery during stent placement, with the subsequent immediate removal of the stent by using an endovascular snare-loop to successfully remove the device.
  
  
  RESULTS
  The PED can be successfully removed using a snare-loop device when indicated. In this case, following removal of the initial PED, the aneurysms can be successfully treated with the placement of a second PED.
  
  
  CONCLUSIONS
  It is critical to have a contingency plan for the removal of malpositioned or otherwise deformed stents that could potentially represent significant sources of iatrogenic stroke.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, 1709 Dryden, Suite 750, Houston, TX 77030, USA.
authors.forename: Bartley
authors.initials: B
authors.lastname: Mitchell
authors.affiliation: Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
authors.forename: Liang-Der
authors.initials: LD
authors.lastname: Jou
authors.affiliation: Neurovascular Center, St. Luke's Episcopal Hospital, Houston, TX 77030, USA ; Department of Neuro-Interventional Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Mawad
keywords: Intracranial; Pipeline embolic device; aneurysm; retrieval; snare loop