title: Novel balloon application for rescue and realignment of a proximal end migrated pipeline flex embolization device into the aneurysmal sac: complication management.
abstract: The pipeline embolization device (PED) has become a routine firstline option for the treatment of an increasing population of intracranial aneurysms at many neurovascular centers. Intraprocedural complications during PED deployment, or complications associated with migration of the device, are rarely reported problems. Significant mismatch in luminal diameter between the inflow vessel and the outflow vessel or excessive dragging-stretching of the PED have been related to 'watermelon seed' or 'accordion' effects, respectively, resulting in stent migration. Here we present a novel balloon technique that was successfully used to realign an in situ flow diverting stent that had prolapsed into a large aneurysm. This represents a useful salvage technique and should be considered when encountering this potential complication.
authors.affiliation: Interventional Neuroradiology, Radiology, Fundacion Jimenez Diaz, Madrid, Madrid, Spain.|Interventional Neuroradiology, Radiology, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Martínez-Galdámez
authors.affiliation: Interventional Neuroradiology, Radiology, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Ortega-Quintanilla
authors.affiliation: Interventional Neuroradiology, Radiology, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Hermosín
authors.affiliation: Interventional Neuroradiology, Radiology, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Crespo-Vallejo
authors.affiliation: Neurosurgery Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Ailagas
authors.affiliation: Interventional Neuroradiology, Radiology, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Pérez
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D019468:Disease Management; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D016879:Salvage Therapy / Q000379:methods; D015607:Stents / Q000009:adverse effects*
keywords: Aneurysm; Flow Diverter