Pipeline embolisation device with shield technology for the treatment of ruptured intracranial aneurysm

Flow diverters have emerged as a safe and effective treatment option for patients with complex unruptured cerebral aneurysms. Their utilisation in patients with ruptured aneurysms poses significant challenges, most notably the need for periprocedural dual antiplatelet medication. We describe the use of the pipeline embolisation device with shield technology in an 88-year-old patient with a complex ruptured posterior communicating artery aneurysm not amenable to microsurgical clipping or coiling alone. The pipeline embolisation device with shield technology utilises a phosphorylcholine coating to decrease thrombotic risk. We describe our antithrombotic protocol and technique to decrease the risk of acute re-rupture. The case highlights the option of using a flow diversion device with antithrombotic coatings in patients with complex ruptured cerebral aneurysms not amenable to coiling or microsurgical clipping.