Presentation
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.
Patient Data
Flow diverting stent before & after images
The diagnostic arteriogram revealed a 12mm x 6mm wide-necked, right internal carotid artery, cavernous segment aneurysm.
Stent in the right internal carotid artery prior to deployment.
Post-deployment of pipeline embolization device in the right internal carotid artery. It follows a path along the cavernous segment of the right internal carotid artery from the superior limb to the inferior limb. The first arrow indicates the superior limb placement of the pipeline embolization device. The second arrow shows the inferior limb endpoint of the stent.
Case Discussion
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."