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Case report
Republished: Pipeline embolization device thrombosis induced peri-construct collateral channels
  1. Albert Ho Yuen Chiu1,
  2. Thomas R Marotta2
  1. 1St Michael's Neurovascular Program, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr A H Y Chiu, St Michael's Neurovascular Program, St Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON M5B 1W8, Canada; albert.h.chiu{at}


More than half a decade of experience and follow-up has now been accumulated with regard to flow diversion as a treatment for intracranial aneurysms; however, many uncertainties, such as the nature of aneurysmal remnants and the meaning of non-regressed, non-perfused aneurysmal masses, are still unknown. Here we discuss a 22-year-old man who presented with a grade 1 subarachnoid hemorrhage secondary to a dissecting right anterior cerebral artery aneurysm who was subsequently treated with a Pipeline Embolization Device construct. After ceasing dual antiplatelet therapy himself, he was found on MRI to have an area of increased aneurysmal remnant reperfusion. This was found to connect to multiple channels which reconstituted flow within the distal construct on angiography. The central area of construct thrombosis could not be visualized on MRI. The finding suggests that non-opacified aneurysmal remnants that have not regressed are biologically active and raises concerns regarding using MRI for long term follow-up.

  • Aneurysm
  • Flow Diverter
  • Blood Flow
  • MRI
  • Angiography

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  • Republished with permission from BMJ Case Reports Published 13 November 2015; doi:10.1136/bcr-2015-012093

  • Contributors AHYC conceived the paper and drafted the article. Both authors revised it for content and gave final approval for the version to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

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