Cavernous Internal Carotid Artery Aneurysm: Visual Disturbance Due to a Large Cavernous Aneurysm Presumably Causing Recurrent Retinal Ischemia; Coil Occlusion of the Aneurysm Together with the Parent Artery; Resolution of the Visual Disturbance and Clinical Recovery During Long-Term Follow-Up

2020 ◽  
pp. 59-68
Author(s):  
Frances Colgan ◽  
Marta Aguilar Pérez ◽  
Hansjörg Bäzner ◽  
Hans Henkes
2019 ◽  
Vol 12 (7) ◽  
pp. e230036 ◽  
Author(s):  
Robert W Young ◽  
Matthew T Bender ◽  
Geoffrey P Colby ◽  
Alexander L Coon

Pipeline embolisation device (PED) ‘twisting’ is an intra-operative complication that manifests with the appearance of a ‘figure-8’ in perpendicular planes on digital subtraction angiography. A twisted PED causes narrowing and/or complete occlusion of the vessel lumen and poses significant risks for thrombus formation and downstream ischaemia. Here, we present a case in which three unique PED implants become twisted during pipeline embolisation of a large fusiform internal carotid artery aneurysm. The twists were remediated by balloon angioplasty and a combination of techniques that allowed the PED to rotate and restore its original axis. Six-month and twelve-month follow-up angiography demonstrated complete aneurysm occlusion with preservation of the parent vessel, proving that proper remediation of PED twisting can still result in successful long-term outcomes.


2019 ◽  
Vol 25 (6) ◽  
pp. 688-691
Author(s):  
Zhongbin Tian ◽  
Shiqing Mu ◽  
Wenqiang Li ◽  
Wei Zhu ◽  
Ying Zhang ◽  
...  

Treatment of selective intracranial aneurysms treated with a Willis covered stent is safe and effective. We describe a previously unreported case of a large, irregular, carotid-ophthalmic aneurysm that was treated with a Willis covered stent. An immediate angiogram after the procedure showed complete occlusion of the aneurysm. However, a six-month follow-up angiogram demonstrated contrast media filling of the aneurysm neck. To the best of our knowledge, this is the first report of a recurrent aneurysm treated with a Willis covered stent because of a membrane partially isolated with the stent. This case suggests that an aneurysm that is treated with a Willis covered stent might recanalise, and the risk of aneurysm rupture persists when the membrane of the stent is isolated with the stent. Therefore, follow-up angiography is necessary, even if an immediate angiogram shows complete aneurysm occlusion. Long-term follow-up is required, and the final outcome of such a case is still unknown.


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