Faculty Collaboration Database

Use of Pipeline™ embolization device for the treatment of traumatic intracranial pseudoaneurysms: Case series and review of cases from literature. Clin Neurol Neurosurg 2018 Jun;169:154-160

Date

04/27/2018

Pubmed ID

29698879

DOI

10.1016/j.clineuro.2018.04.012

Scopus ID

2-s2.0-85046034089 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

OBJECTIVE: Intracranial traumatic pseudoaneurysms (PSA) are a rare but dangerous subtype of cerebral aneurysm. Reports documenting use of flow-diverting stents to treat traumatic intracranial PSAs are few and lack long-term follow-up. To our knowledge, this is the largest case-series to date demonstrating use of Pipeline Endovascular Device (PED) for traumatic intracranial PSAs.

PATIENTS AND METHODS: Retrospective review of 8 intracranial traumatic PSAs in 7 patients treated using only PED placement. Patients were followed clinically and angiographically for at least 6 months.

RESULTS: Seven patients with a mean age of 37 years were treated for 8 intracranial pseudo-aneurysms between 2011-2015. Six aneurysms were the result of blunt trauma; 2 were from iatrogenic injury during transsphenoidal surgery. Mean clinical and angiographic follow-up in surviving patients was 15.2 months. In patients with angiographic follow-up, complete occlusion was achieved in all but one patient, who demonstrated near-complete occlusion. No ischemic events or stent-related stenosis were observed. One patient developed a carotid-cavernous fistula after PED, which was successfully retreated with placement of a second PED. There were two mortalities. One was due to suspected microwire perforation remote from the target aneurysm resulting in SAH/IPH. The other was due to a traumatic SDH and brainstem hemorrhage from an unrelated fall during follow-up interval.

CONCLUSIONS: Use of PED for treatment of intracerebral PSAs following trauma or iatrogenic injury showed good persistent occlusion, and acceptable complication rate for this high-risk pathology. Risks of this procedure and necessary antiplatelet therapy require appropriate patient selection. Larger prospective studies are warranted.

Author List

Sami MT, Gattozzi DA, Soliman HM, Reeves AR, Moran CJ, Camarata PJ, Ebersole KC

MESH terms used to index this publication - Major topics in bold

Adolescent
Aged
Aneurysm, False
Brain Injuries, Traumatic
Child
Female
Follow-Up Studies
Humans
Intracranial Aneurysm
Male
Middle Aged
Retrospective Studies
Self Expandable Metallic Stents
Treatment Outcome
Young Adult