Rescue microsurgery with bypass and stent removal following Pipeline treatment of a giant internal carotid artery terminus aneurysm

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We report the microsurgical rescue and removal of a Pipeline stent embolization of a giant internal carotid artery terminus aneurysm. After the initial placement of a Pipeline Embolization Device (PED), it migrated proximally to the cavernous carotid with the distal end free in the middle of the aneurysm, resulting in only partial aneurysm neck coverage. The patient underwent microsurgical rescue with trapping, bypass, and opening of the aneurysm with PED removal. The vessel remained patent in the proximal segment previously covered by the Pipeline stent. Microsurgical rescue for definitive aneurysm treatment with PED removal can be safe and effective for aneurysms unsuccessfully treated with PED.

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We thank Jennie Williams, MA, for illustrations, Vance Mortimer for assistance with preparation of the video, and Kristin Kraus, MSc, for editorial assistance.

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Correspondence to William T. Couldwell.

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The patient has consented to the submission of this case report to the journal.

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Electronic supplementary material

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Video demonstrating critical portions of the operations for microsurgical rescue and removal of a Pipeline stent embolization of a giant ICA terminus aneurysm. (MP4 34579 kb)

Video 1

Video demonstrating critical portions of the operations for microsurgical rescue and removal of a Pipeline stent embolization of a giant ICA terminus aneurysm. (MP4 34579 kb)

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Bowers, C.A., Taussky, P., Park, M.S. et al. Rescue microsurgery with bypass and stent removal following Pipeline treatment of a giant internal carotid artery terminus aneurysm. Acta Neurochir 157, 2071–2075 (2015).

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  • Pipeline Embolization Device
  • Giant cerebral aneurysm
  • Rescue microsurgery
  • Open vascular surgery
  • Endovascular treatment