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Case report
In situ removal of the pipeline embolization device: the ‘corking’ and ‘pseudo-corking’ techniques
  1. Geoffrey P Colby1,
  2. Juan F Gomez2,
  3. Li-Mei Lin1,
  4. Alexandra R Paul3,
  5. Alexander L Coon1
  1. 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3Division of Neurosurgery, Albany Medical Center, Albany, New York, USA
  1. Correspondence to Dr A L Coon, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 8-181, Baltimore, MD 21287, USA; acoon2{at}jhmi.edu

Abstract

The pipeline embolization device (PED) is a revolutionary tool for the endovascular treatment of intracranial aneurysms by flow diversion. Treatment using the PED often requires considerable manipulation and customization by the neurointerventionalist at the time of deployment. Proper use of the PED involves a novel set of techniques and associated jargon, which must be learned by all neurointerventionalists, fellows and residents for safe treatment of patients with this device. In this report, the PED removal techniques referred to as ‘corking’ and ’pseudo-corking’ are described. Corking is used for the removal of a partially deployed in situ PED when the pusher wire is intact whereas ‘pseudo-corking’ is used if the pusher wire is fractured or disconnected. Knowledge of both techniques is necessary for withdrawing the PED in situations of malposition or failed expansion.

https://doi.org/10.1136/neurintsurg-2011-010234

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval This study was conducted with the approval of the the Institutional Review Board of Johns Hopkins Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.