Successful flow diversion treatment of ruptured infectious middle cerebral artery aneurysms with the use of Pipeline Flex with Shield technology

Abstract

Background Rupture of infectious intracranial aneurysms (IIAs) is associated with a high likelihood of mortality. Endovascular treatment of IIAs via parent artery sacrifice offers good efficacy and outcomes; however, depending on the lesion’s location, neurologic deficit may result. Case description We describe a pediatric patient with ruptured IIAs off the left middle cerebral artery (MCA) treated with coil embolization and endovascular flow diversion using the Pipeline Flex Embolization Device (PED) with Shield technology. We chose to place a flow diverter because 1) there was a second, more distal IIA not amenable to direct coil embolization, 2) there was significant potential for aneurysm regrowth and need for retreatment, and 3) we believed the diseased parent MCA needed to be reconstructed. Conclusions In the setting of previous hemicraniectomy, PED-Shield gave us the option to discontinue dual antiplatelet therapy should the patient require further neurosurgical intervention. Our case supports a role for PED-Shield to address ruptured pseudoaneurysms.

Flow Diversion as Destination Treatment of Intracranial Mycotic Aneurysms: A Retrospective Case Series

“…As discussed in this article, there are very few reports of flow diversion in the setting of mycotic aneurysms. Recently, additional cases of ruptured mycotic aneurysms treated with flow diversion (including stents with surface modification) have been reported, 1a-3a with good outcomes similar to the current case series. These reports suggest that flow diversion is a viable treatment for mycotic aneurysms difficult to treat with traditional methods.…”

Flow diverter stenting for intracranial aneurysms in the pediatric population: Two case reports and literature review

“…Again, 6-month angiogram showed complete obliteration of both aneurysms. 29) While seen to be successful in many case reports, there are four main potential problems related to using flow diverters in pediatrics. First, antiplatelet treatment prior to flow diverters is essential to decrease peri-and post-procedural thromboembolic events.…”

Treatment of an acutely ruptured complex fusiform middle cerebral artery aneurysm with flow diverting stenting and adjunctive coil embolization

“…A ventriculostomy was placed and she was referred for catheter angiography and embolization. [1][2][3][4][5][6][7][8][9][10] 0:53 Initial Diagnostic, Left Internal Carotid Artery (ICA), AP/Lateral. The right wrist was prepped and draped in a sterile fashion and a 22-gauge needle was used to puncture the right radial artery with ultrasound guidance.…”