scholarly journals Multiple pipeline twists encountered during treatment of a symptomatic fusiform ICA aneurysm

2019 ◽  
Vol 12 (7) ◽  
pp. e230036 ◽  
Author(s):  
Robert W Young ◽  
Matthew T Bender ◽  
Geoffrey P Colby ◽  
Alexander L Coon
Keyword(s):  
Internal Carotid ◽  
Thrombus Formation ◽  
Artery Aneurysm ◽  
Long Term Outcomes ◽  
Parent Vessel ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Aneurysm Occlusion

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.

scholarly journals Mid-term follow-up of staged bilateral internal carotid artery aneurysm treatment with Pipeline embolization

2019 ◽  
Vol 25 (6) ◽  
pp. 664-670
Author(s):  
Juan G Tejada ◽  
Gloria VV Lopez ◽  
Jerry ME Koovor ◽  
Kalen Riley ◽  
Mesha Martinez
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Flow Diverter ◽  
Imaging Data ◽  
Carotid Artery Aneurysm ◽  
Common Location ◽  
Internal Carotid Artery Aneurysm

Background Endovascular treatment of large complex morphology aneurysms is challenging. High recanalization rates have been reported with techniques such as stent-assisted coiling and balloon-assisted coiling. Flow diverter devices have been introduced to improve efficacy outcomes and recanalization rates. Thromboembolic complications and in-device stenosis are certainly more worrisome when treatment of bilateral internal carotid arteries has been performed. This study aimed to report our experience with mid-term imaging follow-up of staged bilateral Pipeline embolization device placement for the treatment of bilateral internal carotid artery aneurysms. Methods We reviewed the clinical, angiographic, and follow-up imaging data in all consecutive patients treated with bilateral internal carotid artery aneurysms who underwent elective Pipeline embolization. Results Six female patients were treated, harboring a total of 13 aneurysms. Of these, 60% were asymptomatic. Diplopia and headache were the most common symptoms. The most common location was the paraclinoid segment (6/13), including by cavernous segment (4/13) and ophthalmic segment (2/13). Successful delivery of the device was achieved in 12 cases. Difficult distal access precluded the deployment of the device in one case. The treatment was always staged with at least eight weeks' difference between the two procedures. All aneurysm necks were covered completely. There were no periprocedural complications. Angiographic follow-up ranged between 3 and 12 months, and computed tomography angiogram follow-up ranged between 2 and 24 months. Complete aneurysm occlusion was achieved in all cases. Conclusion In our series, Pipeline deployment for the treatment of bilateral internal carotid artery aneurysms in a staged fashion is safe and feasible. Mid-term imaging follow-up showed permanent occlusion of all the treated aneurysms.

A New Virtual Coiling Method and its Use in Evaluation of Combining Coiling and Flow-Diversion Treatment in a Patient-Specific Aneurysm

2014 ◽  
Author(s):  
Robert Damiano ◽  
Jianping Xiang ◽  
Elad Levy ◽  
Hui Meng
Keyword(s):  
Internal Carotid ◽  
Thrombus Formation ◽  
Artery Aneurysm ◽  
Flow Diverter ◽  
Patient Specific ◽  
Test Case ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Single Flow ◽  
Packing Densities

A new realistic finite element method (FEM) based endovascular coil deployment technique was developed to explore the hemodynamic modifications of coiling in addition to flow diverter (FD) treatment. A patient-specific internal carotid artery aneurysm was used as a test case, and a single flow diverter was deployed using a previously developed method [1], along with several coils using the new method. Results showed fluctuations in hemodynamic parameters at low packing densities (1–3 coils) which are unexpected. At high packing density however (6 coils), results were consistent with expectations. These results suggest that adding coils at low packing densities to FD treatment may not cause significant additional flow reduction into the aneurysm sac, but may provide a scaffold for aneurysmal thrombus formation.

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