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The pipeline flow-diverting stent for exclusion of ruptured intracranial aneurysms with difficult morphologies
Allan R Martin1, Juan Pablo Cruz, Charles C Matouk
1Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Background:
The Pipeline Embolization Device (PED) is a flow-diverting stent that may represent a new therapeutic tool for difficult-to-treat intracranial aneurysms, including those that present with subarachnoid hemorrhage (SAH).
Objective:
To demonstrate the feasibility of utilizing the PED as a primary treatment for ruptured aneurysms with challenging morphologies.
Methods:
Three patients with ruptured intracranial aneurysms presented with SAH. Three distinct and difficult-to-treat aneurysm morphologies were encountered: (1) a small basilar trunk pseudoaneurysm, (2) a carotid artery blister aneurysm, and (3) an A1/A2 junction-dissecting-type aneurysm. All were treated with deployment of one or more PEDs across the aneurysm.
Results:
PEDs were successfully deployed in all 3 cases. Two patients were treated with 2 overlapping PEDs, and the third patient was treated with a single device. Aneurysm obliteration was achieved in all 3 cases with no early rehemorrhage or other clinically adverse event.
Conclusion:
Endovascular treatment with the pipeline flow-diverting stent may be a viable treatment option for otherwise difficult-to-treat aneurysm morphologies in the context of acute SAH.
