Complications After Treatment With Pipeline Embolization for Giant Distal Intracranial Aneurysms With or Without Coil Embolization
- 1 August 2012
- journal article
- case report
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 71 (2), E509-E513
- https://doi.org/10.1227/neu.0b013e318258e1f8
Abstract
The Pipeline Embolization Device (PED) is a flow diverter designed to treat intracranial aneurysms through endoluminal parent vessel reconstruction. The role of adjunctive coil embolization is unknown. This report details the authors' experience with the PED in 2 patients with symptomatic, giant distal intracranial aneurysms (1 basilar artery and 1 M1 segment middle cerebral artery). Both patients had successful parent vessel reconstruction. In the first patient, the basilar artery aneurysm was treated with PEDs alone, and the patient experienced early fatal brainstem hemorrhage from aneurysm rupture. In the second patient, the M1 aneurysm was treated with 2 PEDs along with dense coil embolization, with a good initial angiographic result. This patient experienced acute thrombosis of the PED post-procedure, likely related to mass effect and thrombogenicity of the dense coil mass. Flow diversion is an evolutionary step in the treatment of giant intracranial aneurysms. However, complete aneurysm occlusion occurs over a delayed period. The authors recommend placement of coils in addition to PED in the treatment of large or giant distal intracranial aneurysms in an attempt to protect the dome. However, robust packing is to be avoided because it can lead to acute PED thrombotic or compressive occlusion.Keywords
This publication has 6 references indexed in Scilit:
- Mural destabilization after aneurysm treatment with a flow-diverting device: a report of two casesJournal of NeuroInterventional Surgery, 2011
- The Pipeline Embolization Device for the Intracranial Treatment of Aneurysms TrialAmerican Journal of Neuroradiology, 2010
- Intra-Aneurysmal Thrombosis as a Possible Cause of Delayed Aneurysm Rupture after Flow-Diversion TreatmentAmerican Journal of Neuroradiology, 2010
- Treatment of Intracranial Aneurysms by Functional Reconstruction of the Parent Artery: The Budapest Experience with the Pipeline Embolization DeviceAmerican Journal Of Neuroradiology, 2010
- CURATIVE ENDOVASCULAR RECONSTRUCTION OF CEREBRAL ANEURYSMS WITH THE PIPELINE EMBOLIZATION DEVICENeurosurgery, 2009
- Treatment of experimental carotid aneurysms by endoprosthesis implantation: Preliminary reportNeurological Research, 1993