Flow diverting stent for intracranial aneurysm
Patient presented with increasing migraine headaches. A CTA head and neck in this patient, who had had multiple previously treated aneurysms, showed a new right internal carotid artery, cavernous segment, wide-necked, aneurysm. The diagnostic arteriogram was performed in June of 2014 and, the Pipeline Embolization Device to treat the aneurysm was performed in July 2014.
Flow diverting stent before and after images
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The diagnostic arteriogram revealed a 12mm x 6mm wide-necked, right internal carotid artery, cavernous segment aneurysm.
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The presenting patient, previously treated for two intracranial aneurysms, has a history of alcohol abuse and tobacco use.
Treatment: The patient was treated through femoral artery access. A microcatheter was placed over a smaller microwire and both were moved into position across the neck of the aneurysm. After the microcatheter was in position, a rotating hemostatic valve loaded the Pipeline Embolization Device into a delivery wire, which was then advanced to the aneurysm. Once these devices were in place, unsheathing and delivery wire stabilization were used to deploy the Pipeline Embolization Device across the target landing area. Once the device was deployed, the delivery wire was moved over the microwire to recapture its position.
The flow diverting device was placed to change the flow of blood away from the aneurysm to provide embolization while keeping the parent vessel open. "The stent is a bimetallic design of 75 percent cobalt chromium and 25 percent platinum tungsten; it comprises 48 densely braided strands." (Moskowitz)
Flow diverting stents, especially the pipeline embolization device, help provide another option when dealing with large aneurysms. Stents also help support the vessel wall by not only providing a buttress by a model for the vessel to grow itself around.
The Stanford experience with the Pipeline Embolization Device has shown that "of the approximately 40 patients treated with the device during the last year (2013), no major post-treatment thromboembolic or hemorrhagic strokes occurred."
- Moskowitz, Shaye . "Pipeline Embolization: an Advanced Procedure to Stent Large Proximal Carotid Artery Aneurysms ." A device that received FDA premarket approval in April 2011, the Pipeline Embolization Device allows for true reconstruction of large or giant wide-necked intracranial aneurysms (IAs): n. pag. MD News. Web. 28 July 2014.
- Marks, Michael, Huy Do, and Robert Dodd. "The Evolution in Endovascular Treatment of Hemorrhagic and Ischemic Stroke." Stanford Medicine Neuro-Innovation: Summer 2014. pag. Print.
- Nelson, P.K., P. Lylyk, I. Szikora, S.G. Wetzel, I. Wanke, and D. Fiorella. "The Pipeline Embolization Device for the Intracranial Treatment of Aneurysms Trial." AJNR (2011): 34-40. Web. 12 Aug. 2014. <http://www.ajnr.org/content/32/1/34.full.pdf>.