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Case report
Republished: Novel balloon application for rescue and realignment of a proximal end migrated pipeline flex embolization device into the aneurysmal sac: complication management
  1. Mario Martínez-Galdámez1,2,
  2. Joaquin Ortega-Quintanilla2,
  3. Antonio Hermosín2,
  4. Eduardo Crespo-Vallejo2,
  5. Juan José Ailagas3,
  6. Santiago Pérez2
  1. 1Interventional Neuroradiology, Radiology, Fundacion Jimenez Diaz, Madrid, Madrid, Spain
  2. 2Interventional Neuroradiology, Radiology, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain
  3. 3Neurosurgery Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
  1. Correspondence to Dr M Martínez-Galdámez, Interventional Neuroradiology, Radiology, Fundacion Jimenez Diaz, Avda Reyes Católicos, 2, 28040 Madrid, Spain; mariomgaldamez{at}


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.

  • Aneurysm
  • Flow Diverter

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  • Republished with permission from BMJ Case Reports Published 23 March 2016; doi:10.1136/bcr-2016-012263

  • Contributors Study concept and design, analysis and interpretation of the data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, administrative, technical, and material support, and study supervision: MM-G. Illustrations: AH. Acquisition of the data: all authors.

  • Competing interests MM-G is a consultant for Medtronic Neurovascular and Proctor for the pipeline embolization device.

  • Patient consent Not obtained.

  • Ethics approval The study was approved by the institutional review board.

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