Delayed Retraction of the Pipeline Embolization Device and Corking Failure

BACKGROUND AND IMPORTANCE: The safety of flow-diverting stents for the treatment of ruptured intracranial aneurysms is unknown. CLINICAL PRESENTATION: A 35-year-old woman with a ruptured dissecting aneurysm of the intradural right vertebral artery and incorporating the right posterior inferior cerebellar artery was treated with a Pipeline Embolization Device (PED). Five days after reconstruction of the diseased right vertebral segment, she was treated for vasospasm, and retraction of the PED was observed, leaving her dissecting aneurysm unprotected. A second PED was placed with coverage of the aneurysm, but vasospasm complicated optimal positioning of the device. CONCLUSION: In addition to the potential risks of dual antiplatelet therapy in these patients, this case illustrates 2 pitfalls of flow-diverting devices in vessels in vasospasm: delayed retraction of the device and difficulty positioning the device for deployment in the setting of vasospasm. ABBREVIATIONS: ANR, aneurysm PED, Pipeline Embolization Device PICA, posterior inferior cerebellar artery SAH, subarachnoid hemorrhage