Neurointervention.  2015 Feb;10(1):28-33. 10.5469/neuroint.2015.10.1.28.

Persistent Aneurysm Growth Following Pipeline Embolization Device Assisted Coiling of a Fusiform Vertebral Artery Aneurysm: A Word of Caution!

• Kerolus M
• Kasliwal M
• Lopes DK

• KMID: 1910757
• DOI: http://doi.org/10.5469/neuroint.2015.10.1.28

Abstract

The complex morphology of vertebrobasilar fusiform aneurysms makes them one of the most challenging lesions treated by neurointerventionists. Different management strategies in the past included parent vessel occlusion with or without extra-intracranial bypass surgery and endovascular reconstruction by conventional stents. Use of flow diversion has emerged as a promising alternative option with various studies documenting its efficacy and safety. However, there are various caveats associated with use of flow diversion in patients with fusiform vertibrobasilar aneurysms especially in patients presenting with acute subarachnoid hemorrhage (SAH). We report a rare case of persistent aneurysmal growth after coiling and placement of the Pipeline Embolization Device (PED; ev3, Irvine, California, USA) for SAH from a fusiform vertebral artery aneurysm. As consequences of aneurysm rupture can be devastating especially in patients with a prior SAH, the clinical relevance of recognizing and understanding such patterns of failure cannot be overemphasized as highlighted in the present case.

Keyword

Aneurysm; Complication; Flow Diverter; Pipeline Embolization Device; Recurrence; Subarachnoid Hemorrhage; Treatment

MeSH Terms

Aneurysm*
California
Humans
Parents
Recurrence
Rupture
Stents
Subarachnoid Hemorrhage
Vertebral Artery*

Figure

• 

  Fig. 1 A. Axial computed tomography (CT) scan of the head showing presence of Fisher grade 3 SAH. B. Digital subtraction angiography (DSA) demonstrating right vertebral artery fusiform aneurysm with the PICA takeoff arising from the base of a focal dilatation from the fusiform aneurysm segment. C. Post embolization DSA showing deployment of a 3.75 × 18 mm PED completely covering the fusiform vertebral aneurysm along with Raymond class II occlusion of the focal dilatation arising from the fusiform aneurysm. D. Follow up angiogram at 6 months showing the presence of aneurysm regrowth and coil compaction (left panel) despite well deployed PED across the aneurysm (right panel). E. Anteroposterior (left panel) and lateral (middle and right panels) images from DSA performed 3 months after the second procedure showing remodeling of the right vertebral artery with no residual or recurrent aneurysm.

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