Faculty Collaboration Database

Pipeline Embolization Device as primary treatment for blister aneurysms and iatrogenic pseudoaneurysms of the internal carotid artery. J Neurointerv Surg 2015 Mar;7(3):210-6

Date

03/01/2014

Pubmed ID

24578484

DOI

10.1136/neurintsurg-2013-011047

Scopus ID

2-s2.0-84922718299 (requires institutional sign-in at Scopus site)   67 Citations

Abstract

BACKGROUND: Blood blister type aneurysms (BBAs) and pseudoaneurysms create a unique treatment challenge. Despite many advances in open surgical and endovascular techniques, this subset of patients retains relatively high rates of morbidity and mortality. Recently, BBAs have been treated with flow-diverting stents such as the Pipeline Embolization Device (PED) with overall positive results.

METHODS: Four patients presented with dissecting internal carotid artery (ICA) aneurysms treated with the PED (two BBAs presenting with subarachnoid hemorrhage (SAH), two pseudoaneurysms after injury during endoscopic trans-sphenoidal tumor surgery).

RESULTS: Three patients had a successful angiographic and neurological outcome. One patient with a BBA re-ruptured during initial PED placement, again in the postoperative period, and later died. Primary PED treatment involved telescoping stents in two patients and coil embolization supplementation in one patient.

CONCLUSIONS: The PED should be used selectively in the setting of acute SAH. Dual antiplatelet therapy can complicate hydrocephalus management, and the lack of immediate aneurysm occlusion creates the risk of short-term re-rupture. PED treatment for iatrogenic ICA pseudoaneurysms can provide a good angiographic and neurological outcome.

Author List

Nerva JD, Morton RP, Levitt MR, Osbun JW, Ferreira MJ, Ghodke BV, Kim LJ

Author

John D. Nerva MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin

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

Adult
Aneurysm, False
Blister
Carotid Artery, Internal
Embolization, Therapeutic
Female
Humans
Iatrogenic Disease
Intracranial Aneurysm
Male
Middle Aged
Radiography
Stents
Subarachnoid Hemorrhage
Treatment Outcome