{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:01Z","timestamp":1780736461013,"version":"3.54.1"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>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, the PED has its own unique technical challenges, including the occurrence of device foreshortening or migration leading to prolapse into the aneurysm. The authors sought to determine the incidence of this phenomenon, the rescue strategies, and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Four institutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with PEDs. Patient and aneurysm data as well as angiographic imaging were reviewed for all cases involving device prolapse into the aneurysm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 413 intracranial aneurysms were treated with PEDs during the study period, by 5 neurointerventionalists. Large and giant aneurysms (\u2265 2 cm) accounted for 32 of these aneurysms. Among these 32 PEDs, prolapse into the aneurysm occurred in 3 patients, with 1 of these PEDs successfully rescued and the other 2 left in situ. No patients suffered any severe complications. The 2 patients in whom the PEDs were left in situ remained on antiplatelet therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The PED 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 further evaluate this phenomenon, but some of the observations and techniques described in this paper may help to prevent or salvage prolapsed devices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2017.3.focus1738","type":"journal-article","created":{"date-parts":[[2017,6,1]],"date-time":"2017-06-01T03:36:47Z","timestamp":1496288207000},"page":"E16","source":"Crossref","is-referenced-by-count":17,"title":["Prolapse of the Pipeline embolization device in aneurysms: incidence, management, and outcomes"],"prefix":"10.3171","volume":"42","author":[{"given":"Visish M.","family":"Srinivasan","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew P.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Mokin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Florida, Tampa, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Cherian","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen R.","family":"Chen","sequence":"additional","affiliation":[{"name":"Radiology, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit","family":"Puri","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kan","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg Pediatr","first-page":"31","article-title":"Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion","volume":"14","author":"Abla AA","year":"2014","unstructured":"Abla AA, Zaidi HA, Crowley RW, Britz GW, McDougall CG, Albuquerque FC, : Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion. J Neurosurg Pediatr 14:31\u201337, 2014"},{"issue":"4 Suppl 2","key":"b2","series-title":"Neurosurgery","first-page":"ONS-E380","article-title":"Increased cell opening and prolapse of struts of a neuroform stent in curved vasculature: value of angiographic computed tomography: technical case report","volume":"58","author":"Benndorf G","year":"2006","unstructured":"Benndorf G, Claus B, Strother CM, Chang L, Klucznik RP: Increased cell opening and prolapse of struts of a neuroform stent in curved vasculature: value of angiographic computed tomography: technical case report. Neurosurgery 58 (4 Suppl 2):ONS-E380, 2006"},{"key":"b3","series-title":"Acta Neurochir (Wien)","first-page":"2071","article-title":"Rescue microsurgery with bypass and stent removal following Pipeline treatment of a giant internal carotid artery terminus aneurysm","volume":"157","author":"Bowers CA","year":"2015","unstructured":"Bowers CA, Taussky P, Park MS, Neil JA, Couldwell WT: Rescue microsurgery with bypass and stent removal following Pipeline treatment of a giant internal carotid artery terminus aneurysm. Acta Neurochir (Wien) 157:2071\u20132075, 2015"},{"key":"b4","series-title":"J Neurosurg Pediatr","first-page":"338","article-title":"Surgical bailout of giant supraclinoid ICA aneurysm following treatment with Pipeline Embolization Device","volume":"15","author":"Brasiliense LB","year":"2015","unstructured":"Brasiliense LB, Navarro R, Brazis P, Tawk RG: Surgical bailout of giant supraclinoid ICA aneurysm following treatment with Pipeline Embolization Device. J Neurosurg Pediatr 15:338\u2013339, 2015"},{"issue":"2 Suppl Operative","key":"b5","series-title":"Neurosurgery","first-page":"ons229","article-title":"Delayed migration of a Pipeline Embolization Device","volume":"72","author":"Chalouhi N","year":"2013","unstructured":"Chalouhi N, Satti SR, Tjoumakaris S, Dumont AS, Gonzalez LF, Rosenwasser R, : Delayed migration of a Pipeline Embolization Device. Neurosurgery 72 (2 Suppl Operative):ons229\u2013ons234, 2013"},{"key":"b6","series-title":"AJNR Am J Neuroradiol","first-page":"2326","article-title":"Spontaneous delayed migration\/shortening of the Pipeline Embolization Device: report of 5 cases","volume":"34","author":"Chalouhi N","year":"2013","unstructured":"Chalouhi N, Tjoumakaris SI, Gonzalez LF, Hasan D, Pema PJ, Gould G, : Spontaneous delayed migration\/shortening of the Pipeline Embolization Device: report of 5 cases. AJNR Am J Neuroradiol 34:2326\u20132330, 2013"},{"key":"b7","series-title":"J Neurointerv Surg","first-page":"439","article-title":"Novel application of a balloon-anchoring technique for the realignment of a prolapsed Pipeline Embolization Device: a technical report","volume":"6","author":"Crowley RW","year":"2014","unstructured":"Crowley RW, Abla AA, Ducruet AF, McDougall CG, Albuquerque FC: Novel application of a balloon-anchoring technique for the realignment of a prolapsed Pipeline Embolization Device: a technical report. J Neurointerv Surg 6:439\u2013444, 2014"},{"key":"b8","series-title":"J Neurointerv Surg","first-page":"356","article-title":"Proximal migration and compaction of an Enterprise stent into a coiled basilar apex aneurysm: a posterior circulation phenomenon?","volume":"2","author":"Dashti SR","year":"2010","unstructured":"Dashti SR, Fiorella D, Toledo MM, Hu Y, McDougall CG, Albuquerque FC: Proximal migration and compaction of an Enterprise stent into a coiled basilar apex aneurysm: a posterior circulation phenomenon? J Neurointerv Surg 2:356\u2013358, 2010"},{"key":"b9","series-title":"J Biomech Eng","first-page":"021002","article-title":"Hemodynamics of flow diverters","volume":"139","author":"Dholakia R","year":"2016","unstructured":"Dholakia R, Sadasivan C, Fiorella DJ, Woo HH, Lieber BB: Hemodynamics of flow diverters. J Biomech Eng 139:021002, 2016"},{"key":"b10","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"26","article-title":"Microsurgical strategies following failed endovascular treatment with the Pipeline Embolization Device: case of a giant posterior cerebral artery aneurysm","volume":"16","author":"Ding D","year":"2014","unstructured":"Ding D, Starke RM, Liu KC: Microsurgical strategies following failed endovascular treatment with the Pipeline Embolization Device: case of a giant posterior cerebral artery aneurysm. J Cerebrovasc Endovasc Neurosurg 16:26\u201331, 2014"},{"key":"b11","series-title":"AJNR Am J Neuroradiol","first-page":"E85","article-title":"Possible mechanisms for delayed migration of the closed cell\u2014designed Enterprise stent when used in the adjunctive treatment of a basilar artery aneurysm","volume":"31","author":"Gao B","year":"2010","unstructured":"Gao B, Malek AM: Possible mechanisms for delayed migration of the closed cell\u2014designed Enterprise stent when used in the adjunctive treatment of a basilar artery aneurysm. AJNR Am J Neuroradiol 31:E85\u2013E86, 2010"},{"key":"b12","series-title":"World Neurosurg","first-page":"486.e7","article-title":"An intraoperative look at failure of flow diversion: when additional or alternative treatments should be considered","volume":"93","author":"Gressot LV","year":"2016","unstructured":"Gressot LV, Patel AJ, Srinivasan VM, Arthur A, Kan P, Duckworth EA: An intraoperative look at failure of flow diversion: when additional or alternative treatments should be considered. World Neurosurg 93:486.e7\u2013486.e12, 2016"},{"key":"b13","series-title":"Handbook of Cerebrovascular Disease and Neurointerventional Technique","year":"2013","unstructured":"Harrigan MR, Deveikis JP (eds): Handbook of Cerebrovascular Disease and Neurointerventional Technique, ed 2. New York: Springer, 2013"},{"issue":"2 Suppl Operative","key":"b14","series-title":"Neurosurgery","first-page":"495","article-title":"Retrograde trans-posterior communicating artery snare-assisted rescue of lost access to a foreshortened Pipeline Embolization Device: complication management","volume":"67","author":"Hauck EF","year":"2010","unstructured":"Hauck EF, Natarajan SK, Langer DJ, Hopkins LN, Siddiqui AH, Levy EI: Retrograde trans-posterior communicating artery snare-assisted rescue of lost access to a foreshortened Pipeline Embolization Device: complication management. Neurosurgery 67 (2 Suppl Operative):495\u2013502, 2010"},{"key":"b15","series-title":"Neurosurgery","first-page":"113","article-title":"The Pipeline Embolization Device: learning curve and predictors of complications and aneurysm obliteration","volume":"73","author":"Jabbour P","year":"2013","unstructured":"Jabbour P, Chalouhi N, Tjoumakaris S, Gonzalez LF, Dumont AS, Randazzo C, : The Pipeline Embolization Device: learning curve and predictors of complications and aneurysm obliteration. Neurosurgery 73:113\u2013120, 2013"},{"issue":"Suppl 7","key":"b16","series-title":"Surg Neurol Int","first-page":"S284","article-title":"Techniques in distal access of wide-necked giant intracranial aneurysms during treatment with flow diversion","volume":"6","author":"Kan P","year":"2015","unstructured":"Kan P, Wakhloo AK, Mokin M, Puri A: Techniques in distal access of wide-necked giant intracranial aneurysms during treatment with flow diversion. Surg Neurol Int 6 (Suppl 7):S284\u2013S288, 2015"},{"key":"b17","series-title":"AJNR Am J Neuroradiol","first-page":"1959","article-title":"Delayed migration of a self-expanding intracranial microstent","volume":"29","author":"Kelly ME","year":"2008","unstructured":"Kelly ME, Turner RD IV, Moskowitz SI, Gonugunta V, Hussain MS, Fiorella D: Delayed migration of a self-expanding intracranial microstent. AJNR Am J Neuroradiol 29:1959\u20131960, 2008"},{"key":"b18","series-title":"Neurosurgery","first-page":"E513","article-title":"Early migration of a self-expanding intracranial stent after the treatment of a basilar trunk aneurysm: report of a second case","volume":"69","author":"Khatri R","year":"2011","unstructured":"Khatri R, Rodriguez GJ, Siddiq F, Tummala RP: Early migration of a self-expanding intracranial stent after the treatment of a basilar trunk aneurysm: report of a second case. Neurosurgery 69:E513\u2013E517, 2011"},{"key":"b19","series-title":"Neurointervention","first-page":"10","article-title":"Pipeline Embolization Device for large\/giant or fusiform aneurysms: an initial multi-center experience in Korea","volume":"11","author":"Kim BM","year":"2016","unstructured":"Kim BM, Shin YS, Baik MW, Lee DH, Jeon P, Baik SK, : Pipeline Embolization Device for large\/giant or fusiform aneurysms: an initial multi-center experience in Korea. Neurointervention 11:10\u201317, 2016"},{"key":"b20","series-title":"Interv Neuroradiol","first-page":"129","article-title":"Use of self-expanding stents for better intracranial flow diverter wall apposition","volume":"23","author":"K\u00fchn AL","year":"2017","unstructured":"K\u00fchn AL, Wakhloo AK, Gounis MJ, Kan P, de Macedo Rodrigues K, Lozano JD, : Use of self-expanding stents for better intracranial flow diverter wall apposition. Interv Neuroradiol 23:129\u2013136, 2017"},{"key":"b21","series-title":"Neurosurgery","first-page":"E1012","article-title":"Spontaneous delayed proximal migration of Enterprise stent after staged treatment of wide-necked basilar aneurysm: technical case report","volume":"64","author":"Lavine SD","year":"2009","unstructured":"Lavine SD, Meyers PM, Connolly ES, Solomon RS: Spontaneous delayed proximal migration of Enterprise stent after staged treatment of wide-necked basilar aneurysm: technical case report. Neurosurgery 64:E1012, 2009"},{"key":"b22","series-title":"Neurosurgery","first-page":"142","article-title":"Use of coils in conjunction with the Pipeline Embolization Device for treatment of intracranial aneurysms","volume":"76","author":"Lin N","year":"2015","unstructured":"Lin N, Brouillard AM, Krishna C, Mokin M, Natarajan SK, Sonig A, : Use of coils in conjunction with the Pipeline Embolization Device for treatment of intracranial aneurysms. Neurosurgery 76:142\u2013149, 2015"},{"key":"b23","series-title":"Neurosurgery","first-page":"E516","article-title":"Early migration of a self expanding intracranial stent: case report","volume":"67","author":"Lobotesis K","year":"2010","unstructured":"Lobotesis K, Gholkar A, Jayakrishnan V: Early migration of a self expanding intracranial stent: case report. Neurosurgery 67:E516\u2013E517, 2010"},{"key":"b24","series-title":"World Neurosurg","first-page":"114","article-title":"Pipeline flow-diverter stent for endovascular treatment of intracranial aneurysms: preliminary experience in 20 patients with 27 aneurysms","volume":"76","author":"Lubicz B","year":"2011","unstructured":"Lubicz B, Collignon L, Raphaeli G, De Witte O: Pipeline flow-diverter stent for endovascular treatment of intracranial aneurysms: preliminary experience in 20 patients with 27 aneurysms. World Neurosurg 76:114\u2013119, 2011"},{"key":"b25","series-title":"J Neurointerv Surg","first-page":"e4","article-title":"Novel balloon application for rescue and realignment of a proximal end migrated pipeline flex embolization device into the aneurysmal sac: complication management","volume":"9","author":"Mart\u00ednez-Gald\u00e1mez M","year":"2017","unstructured":"Mart\u00ednez-Gald\u00e1mez M, Ortega-Quintanilla J, Hermos\u00edn A, Crespo-Vallejo E, Ailagas JJ, P\u00e9rez S: Novel balloon application for rescue and realignment of a proximal end migrated pipeline flex embolization device into the aneurysmal sac: complication management. J Neurointerv Surg 9:e4\u2013e4, 2017"},{"issue":"2 Suppl Operative","key":"b26","series-title":"Neurosurgery","first-page":"onsE245","article-title":"Delayed retraction of the Pipeline Embolization Device and corking failure: pitfalls of Pipeline Embolization Device placement in the setting of a ruptured aneurysm","volume":"72","author":"McTaggart RA","year":"2013","unstructured":"McTaggart RA, Santarelli JG, Marcellus ML, Steinberg GK, Dodd RL, Do HM, : Delayed retraction of the Pipeline Embolization Device and corking failure: pitfalls of Pipeline Embolization Device placement in the setting of a ruptured aneurysm. Neurosurgery 72 (2 Suppl Operative):onsE245\u2013ons251, 2013"},{"key":"b27","series-title":"J Vasc Interv Neurol","first-page":"1","article-title":"Retrieval of distorted Pipeline Embolic Device using snare-loop","volume":"7","author":"Mitchell B","year":"2014","unstructured":"Mitchell B, Jou LD, Mawad M: Retrieval of distorted Pipeline Embolic Device using snare-loop. J Vasc Interv Neurol 7:1\u20134, 2014"},{"key":"b28","series-title":"Open J Modern Neurosurg","first-page":"163","article-title":"Fatal outcome after delayed Pipeline Embolization Device migration for the treatment of a giant superior cerebellar artery aneurysm: technical note for complication avoidance","volume":"4","author":"Navarro R","year":"2014","unstructured":"Navarro R, Cano EJ, Brasiliense LBC, Dabus G, Hanel RA: Fatal outcome after delayed Pipeline Embolization Device migration for the treatment of a giant superior cerebellar artery aneurysm: technical note for complication avoidance. Open J Modern Neurosurg 4:163\u2013168, 2014"},{"key":"b29","series-title":"J Neurointerv Surg","first-page":"e7","article-title":"Retrograde trans-anterior communicating artery rescue of unopened Pipeline Embolization Device with balloon dilation: complication management","volume":"7","author":"Navarro R","year":"2015","unstructured":"Navarro R, Yoon J, Dixon T, Miller DA, Hanel RA, Tawk RG: Retrograde trans-anterior communicating artery rescue of unopened Pipeline Embolization Device with balloon dilation: complication management. J Neurointerv Surg 7:e7, 2015"},{"key":"b30","series-title":"J Clin Neurosci","first-page":"1024","article-title":"Use of concentric Solitaire stent to anchor Pipeline flow diverter constructs in treatment of shallow cervical carotid dissecting pseudoaneurysms","volume":"21","author":"Rahal JP","year":"2014","unstructured":"Rahal JP, Dandamudi VS, Heller RS, Safain MG, Malek AM: Use of concentric Solitaire stent to anchor Pipeline flow diverter constructs in treatment of shallow cervical carotid dissecting pseudoaneurysms. J Clin Neurosci 21:1024\u20131028, 2014"},{"key":"b1","series-title":"J Neurosurg Pediatr","first-page":"31","article-title":"Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion","volume":"14","author":"Abla AA","year":"2014","unstructured":"Abla AA, Zaidi HA, Crowley RW, Britz GW, McDougall CG, Albuquerque FC, : Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion. J Neurosurg Pediatr 14:31\u201337, 2014"},{"issue":"4 Suppl 2","key":"b2","series-title":"Neurosurgery","first-page":"ONS-E380","article-title":"Increased cell opening and prolapse of struts of a neuroform stent in curved vasculature: value of angiographic computed tomography: technical case report","volume":"58","author":"Benndorf G","year":"2006","unstructured":"Benndorf G, Claus B, Strother CM, Chang L, Klucznik RP: Increased cell opening and prolapse of struts of a neuroform stent in curved vasculature: value of angiographic computed tomography: technical case report. 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J Neurosurg Pediatr 15:338\u2013339, 2015"},{"issue":"2 Suppl Operative","key":"b5","series-title":"Neurosurgery","first-page":"ons229","article-title":"Delayed migration of a Pipeline Embolization Device","volume":"72","author":"Chalouhi N","year":"2013","unstructured":"Chalouhi N, Satti SR, Tjoumakaris S, Dumont AS, Gonzalez LF, Rosenwasser R, : Delayed migration of a Pipeline Embolization Device. Neurosurgery 72 (2 Suppl Operative):ons229\u2013ons234, 2013"},{"key":"b6","series-title":"AJNR Am J Neuroradiol","first-page":"2326","article-title":"Spontaneous delayed migration\/shortening of the Pipeline Embolization Device: report of 5 cases","volume":"34","author":"Chalouhi N","year":"2013","unstructured":"Chalouhi N, Tjoumakaris SI, Gonzalez LF, Hasan D, Pema PJ, Gould G, : Spontaneous delayed migration\/shortening of the Pipeline Embolization Device: report of 5 cases. 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AJNR Am J Neuroradiol 31:E85\u2013E86, 2010"},{"key":"b12","series-title":"World Neurosurg","first-page":"486.e7","article-title":"An intraoperative look at failure of flow diversion: when additional or alternative treatments should be considered","volume":"93","author":"Gressot LV","year":"2016","unstructured":"Gressot LV, Patel AJ, Srinivasan VM, Arthur A, Kan P, Duckworth EA: An intraoperative look at failure of flow diversion: when additional or alternative treatments should be considered. World Neurosurg 93:486.e7\u2013486.e12, 2016"},{"key":"b13","series-title":"Handbook of Cerebrovascular Disease and Neurointerventional Technique","year":"2013","unstructured":"Harrigan MR, Deveikis JP (eds): Handbook of Cerebrovascular Disease and Neurointerventional Technique, ed 2. 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