The pipeline embolization device (PED) is a well recognized treatment for intracranial aneurysms. However, uncertainty remains regarding its effects on flow alteration, which is particularly highlighted by persistently perfused aneurysmal remnants and non-regressing, non-perfused aneurysmal masses. Here we present a 68-year-old woman with an incidental giant fusiform right paraophthalmic aneurysm electively treated with a PED. After lowering her antiplatelet therapy to promote aneurysm thrombosis, she was found to have a progressively enlarging perfused aneurysmal remnant. Angiography revealed PED occlusion, but curiously the development of a peri-construct collateral channel which feeds the aneurysmal remnant, and gives rise to distal branches and contributes to middle cerebral artery flow. The large 'thrombosed' aneurysmal mass showed tiny internal vessels on cone beam CT angiography as well as florid enhancement on MRI, further confirming that apparently thrombosed remnants are biologically active and may be remodeled depending on flow demand.
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Evolving treatment paradigms of cerebral aneurysm stasis in flow diversion.
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Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address:
Introduction: Flow diversion is an effective first-line treatment for intracranial aneurysms; however, the rate of incomplete occlusion is not insignificant. Data in neuroendovascular literature is limited regarding the implications of persistent incomplete occlusion despite flow diversion.
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Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address:
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View Article and Find Full Text PDFFourth-generation Pipeline Vantage flow diversion: First reported US experience of safety and feasibility.
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Article Synopsis
- The Pipeline Vantage embolization device is a new fourth-generation tool designed to treat intracranial aneurysms, and this study evaluates its safety and effectiveness.
- The research involved 12 patients, primarily women, with a variety of aneurysm types, and demonstrated a 100% success rate in device deployment without intraoperative complications.
- One postprocedural complication occurred, and the findings represent the first US analysis of this device's use in patients with intracranial aneurysms, highlighting its potential for treating both ruptured and unruptured cases.
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