Pipeline Embolization Device as primary treatment for blister aneurysms and iatrogenic pseudoaneurysms of the internal carotid artery

被引:62
作者
Nerva, John D. [1 ]
Morton, Ryan P. [1 ]
Levitt, Michael R. [1 ]
Osbun, Joshua W. [1 ]
Ferreira, Manuel J. [1 ]
Ghodke, Basavaraj V. [1 ,2 ]
Kim, Louis J. [1 ,2 ]
机构
[1] Univ Washington, Harborview Med Ctr, Dept Neurol Surg, Seattle, WA 98104 USA
[2] Univ Washington, Harborview Med Ctr, Dept Radiol, Seattle, WA 98104 USA
关键词
RUPTURED INTRACRANIAL ANEURYSMS; STENT-ASSISTED COILING; ENDOVASCULAR TREATMENT; SUBARACHNOID HEMORRHAGE; CEREBRAL ANEURYSMS; SITES; RISK; WALL;
D O I
10.1136/neurintsurg-2013-011047
中图分类号
R445 [影像诊断学];
学科分类号
100207 ;
摘要
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.
引用
收藏
页码:210 / 216
页数:7
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