Complications associated with treatment of distal aneurysms using the pipeline embolization device
| Case description | Description of complication | Management and outcome |
| Intraprocedural and immediate (first 24 hours) post-procedural complications | ||
| Saccular M2, incidental | Postoperative ipsilateral hemorrhage | Decompressive craniectomy, hematoma evacuation. Patient died. mRS 6 at 3 months |
| Fusiform M2 with downstream ischemic stroke | Slow filling of side branch, resolved after administration of IIb/IIIa inhibitor | Extension of stroke on follow-up imaging, stable neurologic exam without new deficits |
| Saccular P2, incidental | Developed SAH same day post-procedure | Required ventriculoperitoneal shunt, mRS 1 at 3 months |
| Fusiform M2, incidental | Intraprocedural in-stent thrombosis, resolved after administration of IIb/IIIa inhibitor | mRS 0 at 3 months |
| Ruptured P2, dissecting | Intraprocedural in-stent thrombosis, resolved after administration of IIb/IIIa inhibitor and angioplasty. Clinical deterioration 2 days post-procedure, suspected recurrent in-stent thrombosis | Multiple strokes on follow-up MRI, mRS 4 at 3 months |
mRS, modified Rankin Scale; SAH, subarachnoid hemorrhage.