Use of Pipeline™ embolization device for the treatment of traumatic intracranial pseudoaneurysms: Case series and review of cases from literature

被引:23
作者
Sami, Mairaj T. [1 ]
Gattozzi, Domenico A. [1 ]
Soliman, Hesham M. [2 ,5 ]
Reeves, Alan R. [3 ]
Moran, Christopher J. [4 ]
Camarata, Paul J. [1 ]
Ebersole, Koji C. [1 ]
机构
[1] Univ Kansas, Med Ctr, Dept Neurosurg, Mail Stop 3021, Kansas City, KS 66160 USA
[2] Med Coll Wisconsin, Dept Neurosurg, Milwaukee, WI 53226 USA
[3] Univ Kansas, Med Ctr, Dept Radiol, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
[4] Washington Univ, Sch Med, Barnes Jewish Hosp, Mallinckrodt Inst Radiol,Dept Radiol, 510 South Kingshighway Blvd, St Louis, MO 63100 USA
[5] 9200 W Wisconsin Ave, Milwaukee, WI 53226 USA
关键词
Pipeline (TM) embolization device (PED); Trauma; Pseudoaneurysm (PSA); Subarachnoid hemorrhage (SAH); Skull Base fracture; Iatrogenic; Internal carotid artery (ICA); INTERNAL CAROTID-ARTERY; ENDOVASCULAR TREATMENT; ANEURYSMS; MANAGEMENT; OBLITERATION;
D O I
10.1016/j.clineuro.2018.04.012
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:154 / 160
页数:7
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