Background The Pipeline Embolization Device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, PED has its own unique technical challenges, including the occurrence of device foreshortening or migration leading to prolapse into the aneurysm. We sought to determine the incidence of this phenomenon, the rescue strategies, and outcomes.

Methods Four institutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with PED. Patient and aneurysm data as well as angiographic imaging were reviewed for all cases involving device prolapse into the aneurysm.

Results A total of 413 intracranial aneurysms were treated with PED during the study period, by 5 neurointerventionalists. Large and giant aneurysms comprised 32 of these aneurysms. Among these, prolapse into the aneurysm occurred in 3 patients, with one of these being rescued and the other two left in situ. All 3 patients had aneurysms of 2 cm or larger. No patients suffered any neurological complications. The two patients in whom PED was left in situ were left on antiplatelet therapy.

Conclusions The Pipeline Embolization Device may foreshorten or migrate during or after deployment, leading to prolapse into the aneurysm. This phenomenon appears to be associated with large and giant aneurysms, vessel tortuosity, short landing zones, and use of balloon angioplasty. Future study and follow-up is needed to evaluate this further, but some of the observations and techniques described here may help to prevent or salvage prolapsed devices.

Disclosures V. Srinivasan: 1; C; Microvention. A. Carlson: None. M. Mokin: None. J. Cherian: None. S. Chen: None. A. Puri: None. P. Kan: 1; C; Microvention. 2; C; Medtronic, Stryker.