Republished: Pipeline embolization device thrombosis induced peri-construct collateral channels

2015 ◽  
Vol 8 (11) ◽  
pp. e47-e47 ◽  
Author(s):  
Albert Ho Yuen Chiu ◽  
Thomas R Marotta
Keyword(s):  
Anterior Cerebral Artery ◽  
Central Area ◽  
Artery Aneurysm ◽  
Biologically Active ◽  
Pipeline Embolization Device ◽  
Long Term Follow Up ◽  
Anterior Cerebral Artery Aneurysm ◽  
Cerebral Artery Aneurysm

More than half a decade of experience and follow-up has now been accumulated with regard to flow diversion as a treatment for intracranial aneurysms; however, many uncertainties, such as the nature of aneurysmal remnants and the meaning of non-regressed, non-perfused aneurysmal masses, are still unknown. Here we discuss a 22-year-old man who presented with a grade 1 subarachnoid hemorrhage secondary to a dissecting right anterior cerebral artery aneurysm who was subsequently treated with a Pipeline Embolization Device construct. After ceasing dual antiplatelet therapy himself, he was found on MRI to have an area of increased aneurysmal remnant reperfusion. This was found to connect to multiple channels which reconstituted flow within the distal construct on angiography. The central area of construct thrombosis could not be visualized on MRI. The finding suggests that non-opacified aneurysmal remnants that have not regressed are biologically active and raises concerns regarding using MRI for long term follow-up.

scholarly journals Case Report: Traumatic anterior cerebral artery aneurysm in a 4-year old child

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 804 ◽  
Author(s):  
Sunil Munakomi ◽  
Karuna Tamrakar ◽  
Pramod Chaudhary ◽  
Binod Bhattarai ◽  
Iype Cherian
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Pediatric Population ◽  
Artery Aneurysm ◽  
Proximal Part ◽  
Neurological Status ◽  
Pseudo Aneurysm ◽  
Anterior Cerebral Artery Aneurysm ◽  
Cerebral Artery Aneurysm

Traumatic intracranial aneurysm in the proximal part of the anterior cerebral artery in the pediatric population has not been documented so far. Here we report the case of a 4 year-old child who developed a pseudo-aneurysm after minor head trauma and was managed successfully with trapping of the aneurysm. A ventriculo-peritoneal shunt was placed as the child became dependent on extraventricular drain during the post-operative period. The patient made excellent recovery in neurological status within 1 month of post-operative clinical follow up.

Very Late Thrombosis of a Pipeline Embolization Device Construct

2010 ◽  
Vol 67 (3) ◽  
pp. onsE313-onsE314 ◽  
Author(s):  
David Fiorella ◽  
Daniel Hsu ◽  
Henry H. Woo ◽  
Robert W. Tarr ◽  
Peter Kim Nelson
Keyword(s):  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Left Vertebral Artery ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Brainstem Stroke ◽  
Long Term Follow Up ◽  
Late Thrombosis

Abstract BACKGROUND: The Pipeline embolization device (PED) is a new endoluminal construct designed to exclude aneurysms from the parent cerebrovasculature. We report the very late (>;1 year) thrombosis of a PED construct placed for the treatment of a left vertebral aneurysm. CLINICAL PRESENTATION: A patient with an occluded right vertebral artery and a large, fusiform intracranial left vertebral artery aneurysm was treated with PED and coil reconstruction. A durable, complete occlusion of the aneurysm was confirmed with control angiography at 1 year. The patient remained neurologically normal for 23 months until he experienced a transient visual disturbance followed weeks later by a minor brainstem stroke. INTERVENTION: Imaging evaluation showed thrombosis of the PED construct with complete occlusion of the left vertebral artery. After this stroke, he was initially treated with dual antiplatelet therapy and was then converted to warfarin. The patient remained neurologically stable for 5 months until he experienced progressive basilar thrombosis that ultimately resulted in a fatal stroke. CONCLUSION: The PED represents a promising new endovascular technology for the treatment of cerebral aneurysms; however, as an investigational device, long-term follow-up data are sparse at this point. The etiology of the very late thrombosis of the PED construct in this case remains unknown; however, this report underscores the need for a continued, careful systematic evaluation and close long-term follow-up of treated patients.

scholarly journals Complete Recovery from Blindness in Case of Compressive Optic Neuropathy due to Unruptured Anterior Cerebral Artery Aneurysm

2017 ◽  
Vol 8 (1) ◽  
pp. 157-162
Author(s):  
Yurie Fukiyama ◽  
Hidehiro Oku ◽  
Yusuke Hashimoto ◽  
Yuko Nishikawa ◽  
Masahiro Tonari ◽  
...  
Keyword(s):  
Visual Field ◽  
Optic Neuropathy ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Complete Recovery ◽  
Visual Field Defects ◽  
Anterior Cerebral Artery Aneurysm ◽  
The Right ◽  
Cerebral Artery Aneurysm

It is not common for an isolated visual symptom to be the first indication of an aneurysm compressing the optic nerve. The compression can lead to blindness, and a recovery from the blindness is rare. We report a female with a left painless optic neuropathy caused by an unruptured anterior cerebral artery aneurysm. The patient had a temporal hemianopic visual field defect, which progressed to blindness in the left eye, while the right visual function was not affected. A coil embolization of the aneurysm completely restored her visual acuity to 20/20. These findings suggest that aneurysmal lesions should be ruled out in case of unilateral optic neuropathy with hemianopic visual field defects and progressive visual loss.

scholarly journals Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

2018 ◽  
Vol 25 (2) ◽  
pp. 182-186
Author(s):  
Manoj Bohara ◽  
Kosuke Teranishi ◽  
Kenji Yatomi ◽  
Takashi Fujii ◽  
Takayuki Kitamura ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Flow Diversion ◽  
Total Occlusion ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Radiological Features ◽  
Long Term Follow Up ◽  
Aneurysm Occlusion

Background Flow diversion with the Pipeline embolization device (PED) is a widely accepted treatment modality for aneurysm occlusion. Previous reports have shown no recanalization of aneurysms on long-term follow-up once total occlusion has been achieved. Case description We report on a 63-year-old male who had a large internal carotid artery cavernous segment aneurysm. Treatment with PED resulted in complete occlusion of the aneurysm. However, follow-up angiography at four years revealed recurrence of the aneurysm due to disconnection of the two PEDs placed in telescoping fashion. Conclusion Herein, we present the clinico-radiological features and discuss the possible mechanisms resulting in the recanalization of aneurysms treated with flow diversion.

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