Fatal Outcome after Delayed Pipeline Embolization Device Migration for the Treatment of a Giant Superior Cerebellar Artery Aneurysm: Technical Note for Complication Avoidance

Abstract

Purpose: Flow diversion is a relatively novel technique to treat some intracranial aneurysms. With new techniques, unusual complications can occur. We described a case of Pipeline Embolization Device (PED) migration, strategy for its recognition, and a technical point to prevent its occurrence. Publication of these rare events is important to make physicians aware of potential complications. Methods: A patient with a previously coiled giant superior cerebellar aneurysm presented with brainstem compression symptoms. Imaging verified progressive aneurysm growth. A decision was made to treat the aneurysm with PED. Results: Development of new neurologic symptoms prompted a computed tomography that showed hydrocephalus. An angiogram also showed recanalization of the aneurysm secondary to upward migration/retraction of the flow diverter. A ventriculo-peritoneal shunt was implemented and planning for placement of a second flow diverter was made. Unfortunately, the patient expired while waiting for the endovacular intervention. Conclusions: PED migration may occur even after correct placement of the device. Early recognition of this complication is essential. When clinical changes occur, it is paramount that this uncommon, but potentially deadly, complication is suspected. Appropriate sizing and deployment technique are important for the long-term stability of the device.