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Case report
Republished: Pipeline embolization device induced collateral channels in elective flow diversion treatment
  1. Yingming Amy Chen1,
  2. Brian J Drake1,2,
  3. Albert Ho Yuen Chiu1,2,
  4. Thomas R Marotta3
  1. 1Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
  2. 2St Michael's Neurovascular Program, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  3. 3Department 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, Department of Medical Imaging, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada; albert.h.chiu{at}


The pipeline embolization device (PED) is a well recognized treatment for intracranial aneurysms. However, uncertainty remains regarding its effects on flow alteration, which is particularly highlighted by persistently perfused aneurysmal remnants and non-regressing, non-perfused aneurysmal masses. Here we present a 68-year-old woman with an incidental giant fusiform right paraophthalmic aneurysm electively treated with a PED. After lowering her antiplatelet therapy to promote aneurysm thrombosis, she was found to have a progressively enlarging perfused aneurysmal remnant. Angiography revealed PED occlusion, but curiously the development of a peri-construct collateral channel which feeds the aneurysmal remnant, and gives rise to distal branches and contributes to middle cerebral artery flow. The large ‘thrombosed’ aneurysmal mass showed tiny internal vessels on cone beam CT angiography as well as florid enhancement on MRI, further confirming that apparently thrombosed remnants are biologically active and may be remodeled depending on flow demand.

  • Aneurysm
  • Angiography
  • Flow Diverter
  • CT Angiography
  • Device

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  • Republished with permission from BMJ Case Reports Published 4 March 2016; doi:10.1136/bcr-2016-012297

  • Contributors AHYC conceived the paper and curated the images. YAC and BJD drafted the article. All authors revised the paper 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.