Republished: Recurrence of a totally occluded aneurysm after treatment with a pipeline embolization device

2018 ◽  
Vol 11 (9) ◽  
pp. e5-e5 ◽  
Author(s):  
Felipe Padovani Trivelato ◽  
Alexandre Cordeiro Ulhôa ◽  
Marco Tulio Rezende ◽  
Luis Henrique Castro-Afonso ◽  
Daniel Giansante Abud
Keyword(s):  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Middle Cerebral Artery Aneurysm ◽  
Pipeline Embolization Device ◽  
Additional Control ◽  
Aneurysm Occlusion ◽  
Cerebral Artery Aneurysm ◽  
Wide Neck ◽  
Control Angiography

Treatment with a pipeline embolization device (PED) is widely accepted as an excellent option for patients harboring giant, wide neck, saccular intracranial aneurysms. It has been shown to be safe and very effective. We describe a previously unreported case of a large middle cerebral artery aneurysm, related to the carotid tip, that was treated with a PED and coils. The 6 month follow-up angiogram demonstrated complete occlusion of the aneurysm. However, the 9 month angiogram revealed recurrent filling of the aneurysm sac. To our knowledge, this is the first report to describe recanalization of an aneurysm totally occluded on the control angiography after treatment with a PED. Unanswered questions include the mechanism of recanalization and the need for additional control angiograms and MRI following a previous examination revealing total aneurysm occlusion.

scholarly journals Rupture immediately after growth of unruptured intracranial aneurysms during follow-up

2019 ◽  
Vol 10 ◽  
pp. 164
Author(s):  
Taro Yanagawa ◽  
Yoichi Harada ◽  
Toru Hatayama ◽  
Takuji Kono
Keyword(s):  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Resonance Imaging ◽  
Middle Cerebral Artery Aneurysm ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture ◽  
Cerebral Artery Aneurysm

Background: The annual rupture rate of small unruptured intracranial aneurysms (UIAs) <5 mm is generally low; further, small UIAs are often treated conservatively. While the growth of aneurysms during follow-up is associated with a high risk of rupture, the urgency for surgical treatment of asymptomatic enlarged UIAs remains controversial. We experienced two patients in whom UIAs ruptured shortly after asymptomatic growth during follow-up. Case Description: A 1-mm right middle cerebral artery aneurysm was incidentally found in a 63-year-old woman. Preventive surgery was planned because the aneurysm grew rapidly; however, the aneurysm ruptured preoperatively. A 68-year-old woman had a small (4 mm) aneurysm at the left internal carotid-posterior communicating artery. The aneurysm grew rapidly after many years. Several hours after magnetic resonance imaging was performed, she presented to the hospital with loss of consciousness, and a diagnosis of subarachnoid hemorrhage due to the ruptured aneurysm was made. Conclusion: UIAs that rapidly increase during follow-up may be regarded as impending ruptured aneurysms.

Giant Intracranial Aneurysms Presenting with Massive Cerebral Edema

Neurosurgery ◽  
1984 ◽  
Vol 15 (4) ◽  
pp. 572-577 ◽  
Author(s):  
Roberto C. Heros ◽  
Sastry Kolluri
Keyword(s):  
Cerebral Hemisphere ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Brain Swelling ◽  
Middle Cerebral Artery Aneurysm ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

Abstract Two cases of giant left middle cerebral artery aneurysm presenting with rapidly progressing hemiparesis and aphasia are presented. In both, the computed tomographic scan showed recent intraaneurysmal thrombosis and massive edema and swelling of the cerebral hemisphere. There was no evidence of recent hemorrhage in either case. In both patients, surgical resection of the aneurysm was accomplished, but the outcome was disastrous. The literature is reviewed and the possible mechanisms responsible for brain swelling in these cases are discussed.

Rupture of previously documented small asymptomatic saccular intracranial aneurysms

1992 ◽  
Vol 76 (6) ◽  
pp. 1019-1024 ◽  
Author(s):  
Wouter I. Schievink ◽  
David G. Piepgras ◽  
Fremont P. Wirth
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Careful Consideration ◽  
Middle Cerebral Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Cerebellar Artery ◽  
Cerebral Artery Aneurysm

✓ In a recent study from the Mayo Clinic on the natural history of intact saccular intracranial aneurysms, none of the aneurysms smaller than 10 mm in diameter ruptured. It was concluded that these aneurysms carry a negligible risk for future hemorrhage and that surgery for their repair could not be recommended. These findings and recommendations have been the subject of much controversy. The authors report three patients with previously documented asymptomatic intact saccular intracranial aneurysms smaller than 5 mm in diameter that subsequently ruptured. In Case 1, a 70-year-old man bled from a 4-mm middle cerebral artery aneurysm that had been discovered incidentally 2½ years previously during evaluation of cerebral ischemic symptoms. A 10-mm internal carotid artery aneurysm and a contralateral 4-mm middle cerebral artery aneurysm had not ruptured. Case 2 was that of a 66-year-old woman who bled from a 4-mm pericallosal aneurysm that had been present 9½ years previously when she suffered subarachnoid hemorrhage (SAH) from a 7 × 9-mm posterior inferior cerebellar artery aneurysm. Although the pericallosal aneurysm had not enlarged in the intervening years, a daughter aneurysm had developed. The third patient was a 45-year-old woman who bled from a 4- to 5-mm posterior inferior cerebellar artery aneurysm that had measured approximately 2 mm on an angiogram obtained 4 years previously; at that time she had suffered SAH due to rupture of a 5 × 12-mm posterior communicating artery aneurysm. These cases show that small asymptomatic intact saccular intracranial aneurysms are not innocuous and that careful consideration must be given to their surgical repair and long-term follow-up study.

Aneurysms with persistent patency after treatment with the Pipeline Embolization Device

2016 ◽  
Vol 126 (6) ◽  
pp. 1894-1898 ◽  
Author(s):  
Peter Kan ◽  
Visish M. Srinivasan ◽  
Nnenna Mbabuike ◽  
Rabih G. Tawk ◽  
Vin Shen Ban ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Pipeline Embolization Device ◽  
Cerebellar Artery ◽  
Middle Cerebral Artery Aneurysms ◽  
Flow Diverters

The Pipeline Embolization Device (PED) was approved for the treatment of intracranial aneurysms from the petrous to the superior hypophyseal segment of the internal carotid artery. However, since its approval, its use for treatment of intracranial aneurysms in other locations and non-sidewall aneurysms has grown tremendously. The authors report on a cohort of 15 patients with 16 cerebral aneurysms that incorporated an end vessel with no significant distal collaterals, which were treated with the PED. The cohort includes 7 posterior communicating artery aneurysms, 5 ophthalmic artery aneurysms, 1 superior cerebellar artery aneurysm, 1 anterior inferior cerebellar artery aneurysm, and 2 middle cerebral artery aneurysms. None of the aneurysms achieved significant occlusion at the last follow-up evaluation (mean 24 months). Based on these observations, the authors do not recommend the use of flow diverters for the treatment of this subset of cerebral aneurysms.

scholarly journals A novel treatment of a patient with a giant ruptured middle cerebral artery aneurysm by acute coiling followed by scheduled Pipeline flex placement

2020 ◽  
Vol 33 (6) ◽  
pp. 517-519
Author(s):  
Shikai Liang ◽  
Ren Yuan ◽  
Xianli Lv
Keyword(s):  
Middle Cerebral Artery ◽  
Acute Phase ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Aneurysm Rupture ◽  
Flow Diversion ◽  
Neurological Deficits ◽  
Middle Cerebral Artery Aneurysm ◽  
Cerebral Artery Aneurysm

Objective Flow diversion in the acute phase of aneurysm rupture or giant aneurysm is limited by the need for dual antiplatelet therapy and the risk of delayed aneurysm rupture. Here, the authors report a scheduled flow-diversion concept for the endovascular treatment of a giant intra-dural aneurysm. Methods A 54-year-old female patient with a ruptured giant middle cerebral artery aneurysm underwent coiling in the acute phase following 1-month scheduled Pipeline flex placement. Results The acutely ruptured giant middle cerebral artery aneurysm was treated by flow diversion scheduled at 1 month after conventional coiling. The patient tolerated this treatment strategy well without any neurological deficits after the procedure and during the 3-month follow-up. The aneurysm showed nearly complete obliteration on 3-month follow-up angiogram, and a 6- to 12-month follow-up was scheduled. Conclusions This strategy may be considered as an option in patients presenting with ruptured or unruptured giant intra-dural aneurysms.

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