Anterior Cerebral Artery (A1 Segment) Aneurysm: Giant Partially Thrombosed A1 Aneurysm with Mass Effect, Treated with a Pipeline Embolization Device, Complete Resolution of the Mass Effect, and Modification of the Shape of the Implant During Long-Term Follow-Up

  • Rene VisoEmail author
  • Ivan Lylyk
  • Nicolas Perez
  • Esteban Scrivano
  • Pedro Lylyk
Living reference work entry


A giant A1 aneurysm exerting mass effect which was displacing both A1 arteries was found in a 64-year-old male patient who had presented with headaches and diplopia. The patient was treated with a Pipeline Embolization Device with good clinical and angiographic outcomes, with the singularity that the device changed shape as the mass effect from the aneurysm diminished. Actually, management of unruptured giant intracranial aneurysms is a matter of controversy among the neurovascular community. Several endovascular strategies have been used, such as stent-assisted coiling, flow diversion, and flow diversion and coils, with varying occlusion and complication rates reported. In this chapter, we present a case which shows the feasibility of using just one flow diverter stent as a sole treatment method for giant aneurysms. The various therapeutic options for treating of giant aneurysms are the main topic of this chapter.


Anterior cerebral artery ∙ Flow diversion ∙ Pipeline embolization device ∙ Giant aneurysm 


  1. Becske T, Kallmes DF, Saatci I, McDougall CG, Szikora I, Lanzino G, Moran CJ, Woo HH, Lopes DK, Berez AL, Cher DJ, Siddiqui AH, Levy EI, Albuquerque FC, Fiorella DJ, Berentei Z, Marosfoi M, Cekirge SH, Nelson PK. Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology. 2013;267(3):858–68. Epub 2013 Feb 15.CrossRefGoogle Scholar
  2. Becske T, Brinjikji W, Potts MB, Kallmes DF, Shapiro M, Moran CJ, Levy EI, McDougall CG, Szikora I, Lanzino G, Woo HH, Lopes DK, Siddiqui AH, Albuquerque FC, Fiorella DJ, Saatci I, Cekirge SH, Berez AL, Cher DJ, Berentei Z, Marosfoi M, Nelson PK. Long-term clinical and angiographic outcomes following pipeline embolization device treatment of complex internal carotid artery aneurysms: five-year results of the Pipeline for Uncoilable or Failed Aneurysms trial. Neurosurgery. 2017;80(1):40–8. Scholar
  3. Dehdashti AR, Le Roux A, Bacigaluppi S, Wallace MC. Long-term visual outcome and aneurysm obliteration rate for very large and giant ophthalmic segment aneurysms: assessment of surgical treatment. Acta Neurochir. 2012;154(1):43–52. Scholar
  4. Hammoud D, Gailloud P, Olivi A, Murphy KJ. Acute vasogenic edema induced by thrombosis of a giant intracranial aneurysm: a cause of pseudostroke after therapeutic occlusion of the parent vessel. AJNR Am J Neuroradiol. 2003;24(6):1237–9.PubMedGoogle Scholar
  5. Henkes H, Fischer S, Liebig T, Weber W, Reinartz J, Miloslavski E, Kühne D. Repeated endovascular coil occlusion in 350 of 2759 intracranial aneurysms: safety and effectiveness aspects. Neurosurgery. 2008;62(6 Suppl 3):1532–7. Scholar
  6. Kulcsár Z, Houdart E, Bonafé A, Parker G, Millar J, Goddard AJ, Renowden S, Gál G, Turowski B, Mitchell K, Gray F, Rodriguez M, van den Berg R, Gruber A, Desal H, Wanke I, Rüfenacht DA. Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol. 2011;32(1):20–5. Scholar
  7. Lonjon M, Pennes F, Sedat J, Bataille B. Epidemiology, genetic, natural history and clinical presentation of giant cerebral aneurysms. Neurochirurgie. 2015;61(6):361–5. Scholar
  8. Lylyk P, Miranda C, Ceratto R, Ferrario A, Scrivano E, Luna HR, Berez AL, Tran Q, Nelson PK, Fiorella D. Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery. 2009;64(4):632–42.; discussion 642-3; quiz N6CrossRefPubMedGoogle Scholar
  9. Piano M, Valvassori L, Quilici L, Pero G, Boccardi E. Midterm and long-term follow-up of cerebral aneurysms treated with flow diverter devices: a single-center experience. J Neurosurg. 2013;118(2):408–16. Scholar
  10. Szikora I, Marosfoi M, Salomváry B, Berentei Z, Gubucz I. Resolution of mass effect and compression symptoms following endoluminal flow diversion for the treatment of intracranial aneurysms. AJNR Am J Neuroradiol. 2013;34(5):935–9. Scholar
  11. Turowski B, Macht S, Kulcsár Z, Hänggi D, Stummer W. Early fatal hemorrhage after endovascular cerebral aneurysm treatment with a flow diverter (SILK-stent): do we need to rethink our concepts? Neuroradiology. 2011;53(1):37–41. Scholar
  12. van Rooij WJ, Sluzewski M. Unruptured large and giant carotid artery aneurysms presenting with cranial nerve palsy: comparison of clinical recovery after selective aneurysm coiling and therapeutic carotid artery occlusion. AJNR Am J Neuroradiol. 2008;29(5):997–1002. Scholar
  13. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O’Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103–10.CrossRefGoogle Scholar
  14. Zanaty M, Jabbour PM, Bou Sader R, Chalouhi N, Tjoumakaris S, Rosenwasser RH, Fernando Gonzalez L. Intra-aneurysmal thrombus modification after flow-diversion. J Clin Neurosci. 2015;22(1):105–10. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Rene Viso
    • 1
    Email author
  • Ivan Lylyk
    • 1
  • Nicolas Perez
    • 1
  • Esteban Scrivano
    • 1
  • Pedro Lylyk
    • 1
  1. 1.Clinica La Sagrada Familia, ENERIBuenos AiresArgentina

Personalised recommendations