Description:

This soundless video depicts the deployment of a Pipeline embolization device in the setting of an incidentally noted, left-sided 9.9 x 10.4 x 10.5 mm (H x W x AP), wide-necked paraophthalmic aneurysm in a 22-year-old female with known tuberous sclerosis (initial angiogram and 3-D rotational). Subsequent working projections depict the 4.5 x 20 mm Pipeline delivery system within the Marksman microcatheter. The distal device is positioned and released from the coil securing it to the guidewire. The device then is slowly deployed using a technique that combines unsheathing with “pushing” to ensure the device opens fully. The image intensifier is repositioned towards the end to better delineate the device opening within the carotid siphon. Post deployment angiograms reveal stasis within the aneurysm, a positive indicator of occlusion at six months. Video courtesy of Randy S. Bell MD, LCDR, MC, USN; and William O. Bank, MD.