Rescue technique for proximal flow diverter foreshortening leading to dislodgement into aneurysm

Flow diverters (FDs) are an established treatment method for dissecting aneurysms.1, 2, 3 However, device shortening post-deployment and subsequent migration into the aneurysm may pose significant risks.^4,5 In this technical video (Video 1), we present a case of Pipeline Flex Shield deployment for a dissecting aneurysm in the M1 segment of the left middle cerebral artery, where proximal segment shortening with subsequent device migration into the aneurysm sac was observed during the 9-month follow-up evaluation. In this procedure, we successfully advanced a microwire-guided microcatheter through the proximal portion of the compromised stent. Utilizing an exchange technique, the original delivery catheter was replaced to facilitate deployment of a Lattice flow diverter. Final angiography confirmed adequate overlap between the two stents with re-established luminal patency in the parent artery. n analogous clinical scenarios, telescoping stent deployment within the shortened endoprosthesis may constitute a viable salvage strategy.