title: Intra-DIC (distal intracranial catheter) deployment of the Pipeline embolization device: a novel rescue strategy for failed device expansion.
abstract: BACKGROUND
  The Pipeline embolization device (PED) is a braided flow diverter that requires a combination of meticulous maneuvers to assure proper device opening and expansion. Mechanical, anatomical, or technical challenges can result in a partially deployed PED with failed expansion.
  
  
  OBJECTIVE
  To present a new alternative method of PED deployment using the Navien distal intracranial catheter (DIC) as a salvage maneuver for cases where PED opening fails with standard techniques.
  
  
  METHODS
  We retrospectively reviewed a prospective, single-center aneurysm database to identify all patients who underwent endovascular treatment of intracranial aneurysms using the PED with the Navien distal intracranial catheter access platform. Cases requiring PED deployment within the Navien catheter were reviewed. Data was collected for patient demographics, aneurysm characteristics, and technical details of the interventional procedure.
  
  
  RESULTS
  Eleven PED neurointerventions requiring intra-Navien PED deployment to fully open the PED were identified. Mean patient age was 55.5±9.9 years (range 37-76 years). Mean aneurysm size was 12.5 mm±4.9 mm (range 2-42 mm). All aneurysms were located in the anterior circulation (anterior cerebral artery, n=1; supraclinoid, n=1; ophthalmic/paraophthalmic, n=6; cavernous, n=3; petrocervical, n=1). Mean fluoroscopy time was 67.1±20.5 min. The intra-Navien technique was used to open the proximal PED (n=7) and the mid-portion (n=4). Post-processing of the PED with a balloon was used in six cases.
  
  
  CONCLUSIONS
  When a partially deployed PED remains constrained despite exhaustion of standard maneuvers to facilitate opening, the technique of intra-Navien PED deployment is a valuable rescue strategy. This new alternative method of PED deployment can be used to open a stretched device with successful completion of the PED implantation.
authors.affiliation: Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, Orange, California, USA.
authors.forename: Li-Mei
authors.identifier: http://orcid.org/0000-0002-6963-9799
authors.initials: LM
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Colby
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Bowen
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Carolina Neurosurgery & Spine, Greensboro, North Carolina, USA.
authors.forename: Neelesh
authors.initials: N
authors.lastname: Nundkumar
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Tamargo
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Coon
mesh_terms: D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D002405:Catheterization, Central Venous / Q000379:methods*; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Aneurysm; Catheter; Device; Flow Diverter; Technique