Al-Mufti, Fawaz MD; Amuluru, Krishna MD; Cohen, Eric MD; Patel, Vikas MD; El-Ghanem, Mohammad MD; Wajswol, Ethan BS; Dodson, Vincent BS; Al-Marsoummi, Sarmad MD; Majmundar, Neil MD; Dangayach, Neha MD; Nuoman, Rolla MD; Gandhi, Chirag MD
Departments of Neurology and Neurosurgery Westchester Medical Center at New York Medical College Valhalla, New York
Department of Neurointerventional Radiology – Hamot University of Pittsburgh Erie, Pennsylvania
Departments of Neurology and Neurosurgery Rutgers University - Robert Wood Johnson Medical School New Brunswick, New Jersey
Departments of Neurology and Neurosurgery University of Arizona – Tuscon Tuscon, Arizona
Departments of Neurology and Neurosurgery Rutgers University – New Jersey Medical School Newark, New Jersey
Department of Neuroscience University of North Dakota Grand Forks, North Dakota
Departments of Neurology and Neurosurgery Ichan School of Medicine at Mount Sinai New York, New York
Department of Neurology Maria Fareri Children's Hospital at Westchester Medical Center Boston Children's Health Physicians Valhalla, New York
To the Editor,
We thank Drs Srinivasan, Carlson, and Mokin1 for their interest in our study.2 Flow-Diverting Devices (FDD) have transformed the landscape of neuroendovascular surgery however the rates of intraprocedural complication and management of these complications remains ill defined. Hence we sought to summarize rescue strategies for procedural complications associated with deployment of FDD in cerebral aneurysms.
The publication of Srinivasan et al3 work occurred during the interval between the submission and acceptance of our work in Operative Neurosurgery hence we were unable to cite their work. Prolapse of FDD is a rare complication and the work that the authors did is invaluable in highlighting the incidence, management, and outcomes of FDD prolapse. In their review of 413 aneurysms, prolapse of the FDD into the aneurysm occurred in 3 patients with the giant aneurysms.3 Prolapse of FDD only occurred in patients with giant aneurysms (≥2 cm). Of these 3 cases, 1 was successfully rescued and the other 2 were left in situ with no adverse events at >48 mo follow-up.
We agree with the authors that a conservative strategy of leaving the prolapsed FDD in situ without rescue and continuing antiplatelet agents may be a valid option in some case. Future prospective studies will be needed to further evaluate this rare complication.
Disclosures
The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
REFERENCES
1. Srinivasan VM, Kan P. Letter: rescue therapy for procedural complications associated with deployment of flow diverting devices in cerebral aneurysms. Oper Neurosurg. 2019;17(2):E91.
2. Al-Mufti F, Amuluru K, Cohen ER, et al. Rescue therapy for procedural complications associated with deployment of flow-diverting devices in cerebral aneurysms. Oper Neurosurg. 2018;15(6):624-633.
3. Srinivasan VM, Carlson AP, Mokin M, et al. Prolapse of the pipeline embolization device in aneurysms: incidence, management, and outcomes. Neurosurg Focus. 2017;42(6):E16.
