title: Pipeline embolization device deployment via an envoy distal access XB guiding catheter-biaxial platform: A technical note.
abstract: With the increased reliance on the Pipeline embolization device (PED) for the treatment of complex intracranial aneurysms, our experience in managing intraoperative complications and challenges continues to accumulate amid a scarcity of reports on rescue strategies and innovative techniques. We describe the case of a 50-year-old woman who presented for elective repeat embolization of a right posterior communicating artery aneurysm with some residual aneurysmal filling. During the procedure the patient developed severe vasospasm due to vessel irritation and this led us to proceed to deploy the PED through a biaxial construct composed of the 6 French Envoy MPD DA XB, and the Marksman catheters. The biaxial construct in select patients may provide the required stability while eliminating the need for an intermediate catheter, minimizing embolic risk, and allowing for less irritation to the vessel. Larger studies are required for further validation.
authors.affiliation: Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, USA fa299@njms.rutgers.edu.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Al-Mufti
authors.affiliation: Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Amuluru
authors.affiliation: Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, USA Department of Neurology, Rutgers University School of Medicine, USA.
authors.forename: Inder Paul
authors.initials: IP
authors.lastname: Singh
authors.affiliation: Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, USA Department of Neurology, Rutgers University School of Medicine, USA Department of Radiology, Rutgers University School of Medicine, USA.
authors.forename: Chirag
authors.initials: C
authors.lastname: Gandhi
authors.affiliation: Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, USA Department of Neurology, Rutgers University School of Medicine, USA Department of Radiology, Rutgers University School of Medicine, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Prestigiacomo
mesh_terms: D015901:Angiography, Digital Subtraction; D002404:Catheterization; D057785:Catheters; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D007431:Intraoperative Complications / Q000628:therapy; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D020769:Posterior Cerebral Artery; D015607:Stents; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000628:therapy
keywords: Pipeline embolization device