Internal Carotid Artery Aneurysm: Giant Supraclinoid Aneurysm Treated with Telescoping p64 Flow Diverters with Complete Occlusion of the Aneurysm
- 72 Downloads
A symptomatic giant supraclinoid aneurysm was found in a 68-year-old female patient who had a history of mild hypertension. She presented with episodes of severe headache and visual disturbance of the right eye. The aneurysm was treated with a telescoping technique using two p64 flow-diverter stents (phenox). The patient was prepared for the stent implants with a course of dual-platelet function inhibition using acetylsalicylic acid (ASA) and clopidogrel 5 days prior to the procedure. The original plan for the procedure was to use a single flow-diverter device, but in the immediate DSA after the deployment of the first device, there was still a considerable amount of flow entering into the aneurysm sac. Therefore, a second device was placed, overlapping the first p64 at the aneurysm neck in order to further increase the flow diversion effect. The procedure was completed without any complications, and the patient was discharged after 3 days. The patient showed rapid clinical improvement. In the follow-up DSA performed 1 year after the procedure, the aneurysm was angiographically completely occluded, and the flow diverters as well as the parent vessel remained patent. On MRI no significant shrinkage of the meanwhile thrombosed aneurysm sac was encountered. The use of flow diverters to treat aneurysms located in the supraclinoid segment of the ICA is the main topic of this chapter.
KeywordsSupraclinoid ICA Flow diversion Complete angiographic occlusion Telescoping flow-diverter stents Space-occupying effect Giant aneurysm
- Damiano RJ, Tutino VM, Paliwal N, Ma D, Davies JM, Siddiqui AH, Meng H. Compacting a single flow diverter versus overlapping flow diverters for intracranial aneurysms: a computational study. AJNR Am J Neuroradiol. 2017;38(3):603–10. https://doi.org/10.3174/ajnr.A5062.CrossRefPubMedPubMedCentralGoogle Scholar
- Kallmes DF, Hanel R, Lopes D, Boccardi E, Bonafé A, Cekirge S, Fiorella D, Jabbour P, Levy E, McDougall C, Siddiqui A, Szikora I, Woo H, Albuquerque F, Bozorgchami H, Dashti SR, Delgado Almandoz JE, Kelly ME, Turner R 4th, Woodward BK, Brinjikji W, Lanzino G, Lylyk P. International retrospective study of the pipeline embolization device: a multicenter aneurysm treatment study. AJNR Am J Neuroradiol. 2015;36(1):108–15. https://doi.org/10.3174/ajnr.A4111.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.3174/ajnr.A2370.CrossRefPubMedGoogle Scholar
- 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 N6. https://doi.org/10.1227/01.NEU.0000339109.98070.65.
- Sahlein DH, Fouladvand M, Becske T, 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, Kallmes DF, Nelson PK. Neuroophthalmological outcomes associated with use of the pipeline embolization device: analysis of the PUFS trial results. J Neurosurg. 2015;123(4):897–905. https://doi.org/10.3171/2014.12.JNS141777.CrossRefPubMedGoogle Scholar
- Shojima M. Basic fluid dynamics and tribia related to flow diverter. J Neuroendovasc Ther. 2017;11(3):109–16. https://doi.org/10.5797/jnet.ra-diverter.2016-0012.CrossRefGoogle Scholar
- Szikora I, Berentei Z, Kulcsar Z, Marosfoi M, Vajda ZS, Lee W, Berez A, Nelson PK. Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. AJNR Am J Neuroradiol. 2010;31(6):1139–47. https://doi.org/10.3174/ajnr.A2023.CrossRefPubMedGoogle Scholar