Delayed spontaneous rupture of cavernous segment of the internal carotid artery following dual ophthalmic segment aneurysms treatment with pipeline embolization device

Background Subarachnoid hemorrhage (SAH) secondary to rupture of a blister aneurysm (BA) results in high morbidity and mortality. Endovascular treatment with the pipeline embolization device (PED) has been described as a new treatment strategy for these lesions. We present the first reported case of PED retraction and foreshortening after treatment of a ruptured internal carotid artery (ICA) BA. Case description A middle-aged patient presented with SAH secondary to ICA BA rupture. The patient was treated with telescoping PED placement across the BA. After 5 days from treatment, the patient developed a new SAH due to re-rupture of the BA. Digital subtraction angiography revealed an increase in caliber of the supraclinoid ICA with associated retraction and foreshortening of the PED that resulted in aneurysm uncovering and growth. Conclusions PED should be oversized during ruptured BA treatment to prevent device retraction and aneurysm regrowth. Frequent imaging follow up after BA treatment with PED is warranted to ensure aneurysm occlusion.

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Pipeline embolization device treatment of internal carotid artery terminus aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014312 ◽

2018 ◽

Vol 11 (5) ◽

pp. 485-488 ◽

Cited By ~ 5

Author(s):

Amit Pujari ◽

Brian Matthew Howard ◽

Thomas P Madaelil ◽

Susana Libhaber Skukalek ◽

Anil K Roy ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Treatment Strategies ◽

Maximum Diameter ◽

Class Iii ◽

Pipeline Embolization Device ◽

Proximal Internal Carotid Artery ◽

The Mean

BackgroundThe pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied.MethodsWe conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded.ResultsMean age was 46.9 years (± 8.8), and 6 (60%) patients were women. The mean maximum diameter of the aneurysms treated was 14.7 mm (± 10.7) and the mean neck diameter was 9.3 mm (± 6.6). Reasons for presentation included six incidental findings, one acute subarachnoid hemorrhage (SAH), and three patients with prior SAH. Kamran–Byrne Occlusion Scale scores for the treated aneurysms were as follows: three class IV (complete obliteration), four class III (<50% filling in both height and width for fusiform aneurysms or residual neck for saccular aneurysms), one class II fusiform aneurysm, 1 class 0 saccular aneurysm (residual aneurysm body), and one not classified due to pipeline thrombosis. Two clinically asymptomatic complications were noted: one patient who had a small distal cortical SAH post PED and one patient whose stent was found to be thrombosed on follow-up angiogram. All patients were seen in follow-up, and no patients were found to have worsening of their pre-procedure modified Rankin Scale score.ConclusionThe PED has potential for treating ICA-T aneurysms not amenable to conventional treatment strategies. Further studies are warranted to confirm the long term outcomes.

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Antiplatelet therapy and periprocedural risk factor analysis for Pipeline embolization device treatment of unruptured internal carotid artery aneurysms: A retrospective, multicenter analysis

World Neurosurgery ◽

10.1016/j.wneu.2021.09.109 ◽

2021 ◽

Author(s):

Hisayuki Hosoo ◽

Eiichi Ishikawa ◽

Wataro Tsuruta ◽

Masayuki Sato ◽

Yoshiro Ito ◽

...

Keyword(s):

Factor Analysis ◽

Risk Factor ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Antiplatelet Therapy ◽

Internal Carotid ◽

Risk Factor Analysis ◽

Pipeline Embolization Device ◽

Multicenter Analysis

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Parameters for Contralateral Approach to Ophthalmic Segment Aneurysms of the Internal Carotid Artery

Neurosurgery ◽

10.1097/00006123-200011000-00022 ◽

2000 ◽

Vol 47 (5) ◽

pp. 1130-1137 ◽

Cited By ~ 45

Author(s):

Yukinari Kakizawa ◽

Yuichiro Tanaka ◽

Yasser Orz ◽

Tomomi Iwashita ◽

Kazuhiro Hongo ◽

...

Keyword(s):

Optic Nerve ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Bone Resection ◽

Pterional Approach ◽

Aneurysm Neck ◽

Contralateral Approach ◽

Ophthalmic Segment Aneurysms ◽

Contralateral Pterional Approach

Abstract OBJECTIVE This study was undertaken to define more accurately the feasibility and indications of the contralateral pterional approach to ophthalmic segment aneurysms of the internal carotid artery (ICA). METHODS Between 1995 and 1999, 46 patients with ophthalmic segment aneurysms of the ICA were surgically treated in our institution. Eleven of the 46 aneurysms were operated using the contralateral pterional approach. All aneurysms were successfully clipped without complications; three patients required bone resection around the aneurysm neck. We studied the 11 patients who were treated with the contralateral approach by defining six parameters to assess the feasibility of the approach and to predict the necessity for bone resection: 1) Parameter A, the distance between the anterior aspect of the optic chiasm and the limbus sphenoidale; 2) Parameter B, the distance between the bilateral optic nerves at the entrance to the optic canal; 3) Parameter C, the interrelation of the optic nerve and the ICA, expressed as a/b in which a is the length from the midline to the optic nerve and b is the length from the midline to the ICA; 4) Parameter D, the size of the aneurysm neck; 5) Parameter E, the direction of the aneurysm from the ICA wall on the anteroposterior angiogram; and 6) Parameter F, the distance from the medial side of the estimated distal dural ring to the proximal aneurysm neck on the lateral angiogram. RESULTS Parameters A to F were 8.8 mm (range, 5.4–11.1 mm), 14.5 mm (range, 10.4–22.2 mm), 0.9 mm (range, 0.6–1.3 mm), and 3.0 mm (range, 2.3–4.7 mm), 5 to 160 degrees, and 1.3 mm (range, 0.3–2.4 mm), respectively. All patients had excellent operative outcomes without visual dysfunction. Three patients required drilling of the bone around the optic canal on the craniotomy side; bone drilling was not required when Parameter E was between 30 and 160 degrees and Parameter F was more than 1 mm. CONCLUSION Parameters A to D are important for assessing the feasibility of the contralateral approach to ICA-ophthalmic segment aneurysms, and Parameters E and F are most useful for calculating the difficulty of this approach.

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Flow Diverter Therapy Using a Pipeline Embolization Device for 100 Unruptured Large and Giant Internal Carotid Artery Aneurysms in a Single Center in a Japanese Population

Neurologia medico-chirurgica ◽

10.2176/nmc.oa.2018-0148 ◽

2018 ◽

Vol 58 (11) ◽

pp. 461-467 ◽

Cited By ~ 12

Author(s):

Hidenori OISHI ◽

Kosuke TERANISHI ◽

Kenji YATOMI ◽

Takashi FUJII ◽

Munetaka YAMAMOTO ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Japanese Population ◽

Internal Carotid ◽

Flow Diverter ◽

Single Center ◽

Pipeline Embolization Device

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Flow diverter for endovascular treatment of intracranial mirror segment internal carotid artery aneurysms

Interventional Neuroradiology ◽

10.1177/1591019918792536 ◽

2018 ◽

Vol 25 (1) ◽

pp. 4-11 ◽

Cited By ~ 2

Author(s):

Anna Luisa Kühn ◽

Peter Kan ◽

Visish Srinivasan ◽

David E Rex ◽

Katyucia de Macedo Rodrigues ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Temporal Artery ◽

Flow Diverter ◽

Post Treatment ◽

Pipeline Embolization Device ◽

Device Placement ◽

Aneurysm Occlusion

Background To evaluate the feasibility and efficacy of the pipeline embolization device in the treatment of unruptured intracranial mirror segment aneurysms. Methods Out of a total of 338 subjects, 14 were identified harboring a total of 32 internal carotid artery mirror segment aneurysms that were treated with the pipeline embolization device and were consecutively enrolled into our study. We collected data on patient demographics, modified Rankin scale (mRS) at admission, aneurysm characteristics, clinical outcome at discharge, 3–9 and at 12–18 months as well as angiography results at follow-up. Results Patients’ mean age was 52.9 years; baseline mRS was 0 in all subjects. Pipeline embolization device placement was successful in all cases. Post-treatment mRS remained 0 in 13/14 patients. One patient experienced a small intraparenchymal hemorrhage and subarachnoid hemorrhage, associated with a frontoparietal infarction resulting in right upper extremity weakness and aphasia (post-treatment mRS 3). His mRS evaluation remained stable at the 3–9-month follow-up. Three to 9-month follow-up angiography (13/14 subjects) showed complete aneurysm occlusion in 24/30 aneurysms (80%), near complete and partial occlusion in three of 30 (10%) aneurysms each. At the 9-month follow-up, one patient experienced a complete occlusion of the anterior temporal artery branch but did not present with any clinical deficits. No mRS changes were encountered over a median 6-month follow-up period. Mid-term follow-up angiography (12–18 months) available in eight of 14 subjects showed complete aneurysm occlusion in all patients. Mild intimal hyperplasia was observed in one patient. Conclusions Flow diversion technology can be used for the treatment of unruptured mirror segment aneurysms in selected patients.

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Hemodynamic Fate of the Precommunicating Anterior Cerebral Artery Is Predicted by Vessel Dominance After Pipeline Embolization Device Deployment Across the Internal Carotid Artery Terminus

World Neurosurgery ◽

10.1016/j.wneu.2019.04.234 ◽

2019 ◽

Vol 128 ◽

pp. e688-e693

Author(s):

Amit Pujari ◽

Brian M. Howard ◽

Susana L. Skukalek ◽

Jacob Cherian ◽

Alhamza Al-Bayati ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Anterior Cerebral Artery ◽

Pipeline Embolization Device ◽

Device Deployment

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Regrowth of a Large Intracranial Aneurysm after On-Label Use of the Pipeline Embolization Device

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_273_18 ◽

2019 ◽

Vol 10 (01) ◽

pp. 142-144 ◽

Cited By ~ 2

Author(s):

Ching-Jen Chen ◽

M. Rao Patibandla ◽

Min S. Park ◽

M. Yashar Kalani

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Intracranial Aneurysm ◽

Internal Carotid ◽

Pipeline Embolization Device ◽

Complete Occlusion ◽

Residual Component ◽

First Case ◽

Aneurysm Occlusion

ABSTRACTDespite the widespread use of the pipeline embolization device (PED), no complete aneurysm regrowth after its placement has been reported in the literature. We report the first case of aneurysm regrowth after the initial follow-up angiography demonstrating near-complete occlusion of the aneurysm and remodeling of the vessel with on-label PED use for a large 20 mm × 24 mm × 22 mm (width × depth × height) cavernous segment internal carotid artery (ICA) aneurysm. The patient was treated with two overlapping PED (4.5 mm × 20 mm and 5 mm × 20 mm). Follow-up angiogram at 4 months after treatment demonstrated remodeling of the ICA with a small residual component measuring approximately 7 mm × 8 mm × 7 mm. However, at 10 months after treatment, there was a complete regrowth of the aneurysm with interval growth, now measuring 25 mm × 28 mm × 18 mm. Despite the high aneurysm occlusion rates reported with the PED, persistent aneurysm filling and aneurysm regrowth, although rare, should not be overlooked.

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Transcirculation Pipeline embolization device deployment: a rescue technique

Neurosurgical FOCUS ◽

10.3171/2017.2.focus16485 ◽

2017 ◽

Vol 42 (6) ◽

pp. E13 ◽

Cited By ~ 1

Author(s):

Edison P. Valle-Giler ◽

Elias Atallah ◽

Stavropoula Tjoumakaris ◽

Robert H. Rosenwasser ◽

Pascal Jabbour

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Cerebral Aneurysms ◽

Artery Aneurysm ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Anterior Communicating Artery ◽

Pipeline Embolization Device ◽

Contralateral Internal Carotid Artery

The Pipeline embolization device (PED) has become a very important tool in the treatment of nonruptured cerebral aneurysms. However, a patient’s difficult anatomy or vascular stenosis may affect the device delivery. The purpose of this article was to describe an alternate technique for PED deployment when ipsilateral anatomy is not amenable for catheter navigation.A 44-year-old woman with a symptomatic 6-mm right superior hypophyseal artery aneurysm and a known history of right internal carotid artery dissection presented for PED treatment of her aneurysm. An angiogram showed persistence of the arterial dissection with luminal stenosis after 6 months of dual antiplatelet treatment. The contralateral internal carotid artery was catheterized and the PED was deployed via a transcirculation approach, using the anterior communicating artery. Transcirculation deployment of a PED is a viable option when ipsilateral anatomy is difficult or contraindicated for this treatment.

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