Abstract
Purpose
To describe a novel configuration of pipeline embolization device for internal carotid bifurcation region aneurysm, named horizontal stenting.
Clinical presentation
A 64-year-old woman, with visual deficit, harboring a large wide-necked aneurysm located at the junction between left internal carotid artery and left A1 segment of anterior cerebral artery, was submitted to endovascular treatment. As she had pre-existing occlusion of left internal carotid, approach from the contralateral internal carotid was used to advance the pipeline embolization device through the anterior communicating artery and place the flow diverter horizontally across the neck (from M1 to A1). Coil embolization was also performed through a microcatheter navigated via posterior communicating artery. The intervention was uneventful, with total aneurysm occlusion. Patient presented with visual improvement on follow-up.
Conclusion
Horizontal deployment of pipeline embolization device appears to be an acceptable and feasible alternative to treat internal carotid bifurcation aneurysms. Long-term follow-up and a greater number of cases are mandatory to establish the safety of this strategy.
Similar content being viewed by others
References
Leung GKK, Tsang ACO, Lui WM. Pipeline embolization device for intracranial aneurysm: a systemic review. Clin Neuroradiol. 2012;22:295–303.
Saleme A, Iosif C, Ponomarjova S, Mendes G, Camilleri Y, Caire F, Boncoeur MP, Mounayer C. Flow-diverting stents for intracranial bifurcation aneurysm treatment. Neurosurgery. 2014;75:623–31.
Pistocchi S, Blanc R, Bartolini B, Piotin M. Flow diverters at and beyond the level of the circle of Willis for the treatment of intracranial aneurysm. Stroke. 2012;43:1032–8.
Kono K, Terada T. Hemodynamics of 8 different configurations of stenting for bifurcation aneurysms. AJNR Am J Neuroradiol. 2013;34:1980–6.
Moret J, Boss IB, Piotin M. The retrograde approach: a consideration for the endovascular treatment of aneurysms. AJNR Am J Neuroradiol. 2000;21:262–8.
Cross DT, III, Moran CJ, Derdeyn CP, Mazumbar A, River D, Chicoine MM. Neuroform stent deployment for treatment of a basilar tip aneurysm via a posterior communicating artery route. AJNR Am J Neuroradiol. 2005;26:2578–81.
Black SL, Kadkhodayan Y, Shekhtman E, Derdeyn CP, Cross DT, III, Christopher M. Treatment of basilar tip aneurysms with horizontal PCA to PCA stent-assisted coiling: case series. J Neurointervent Surg. 2013;5:212–6.
Bendorf G, Klucznik RP, Meyer D, Strother CM, Mawad ME. “Cross-over” technique for horizontal stenting of an internal carotid bifurcation aneurysm using a new self-expandable stent: technical case report. Neurosurgery. 2006;58(Suppl 1):ONS–E172.
Siddiqui MA, Bhattacharya JJ, Lindsay KW, Jenkins S. Horizontal stent-assisted coil embolization of wide-necked intracranial aneuryms with the enterprise stent—a case series with early angiographic follow-up. Neuroradiology. 2009;51:411–8.
Puffer RC, Piano M, Lanzino G, Valvassori L, Kallmes DF, Quilici L, Cloft HJ, Boccardi E. Treatment of cavernous sinus aneurysms with flow diversion: results in 44 patients. AJNR Am J Neuroradiol. 2014;35:948–51.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Trivelato, F., Araújo, J., Salles Rezende, M. et al. A Novel Configuration of Pipeline Embolization Device for Internal Carotid Bifurcation Region Aneurysms: Horizontal Deployment. Clin Neuroradiol 27, 57–60 (2017). https://doi.org/10.1007/s00062-015-0414-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00062-015-0414-y