• Edward A M Duckworth, Christopher Nickele, Daniel Hoit, Andrey Belayev, Christopher J Moran, and Adam S Arthur.
• Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
• BMJ Case Rep. 2015 Jan 30; 2015.

AbstractFlow diversion for the management of intracranial aneurysms represents a paradigm shift in how aneurysms are managed. The Pipeline embolization device (PED) is, to date, the only flow diverter approved for use in the USA by the Food and Drug Administration. Limitations and complications with new treatment strategies are inevitable, and with the PED there have been reports of complications, most commonly with challenging deployments. Once deployment has been initiated, the device is 'one-way'; it can only be deployed further or removed. Yet, situations arise in which the ability to recapture or reposition the device would be advantageous. A second-generation Pipeline has been developed that addresses these concerns. We report the first use in North America of this second-generation Pipeline device: the Pipeline Flex. We discuss our rationale for using the device, our impressions of its operation, and the relevant literature concerning the current state of flow diversion. 2015 BMJ Publishing Group Ltd.

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