Feeding Artery Recurrent Aneurysm Treated with a p64 Flow Diverter

  • Hans Henkes
  • Marta Aguilar Pérez


This 38-year-old woman had a history of occasional partial and complex seizures associated with a large brain AVM of the left frontal and temporal lobe. In October 2015, MRI showed a minor SAH as the reason of severe headache (Figs. 29.1 and 29.2). An aneurysm of the left ICA at the origin of the left AchoA, which among other vessels supplied the AVM, was occluded with coils (Figs. 29.3 and 29.4). A reperfusion of this aneurysm was found only 2 months later (Fig. 29.5). A second coil occlusion of the aneurysm was carried out another 3 months later (Fig. 29.6). The brain AVM was partially embolized and was irradiated with a CyberKnife in May 2016. Six weeks later, severe headache and an increased frequency of seizures occurred. MRI and DSA revealed a hematoma in the left frontal lobe, an early obliteration of a significant part of the AVM and again a recurrent perfusion of the AchoA aneurysm (Fig. 29.7). The aneurysm was obliterated in third coil procedure (Fig. 29.8). Follow-up DSA after only 4 weeks again showed a reperfusion of the aneurysm (Fig. 29.9a). The origin of the left AchoA and the aneurysm were now covered by a p64 flow diverter (Fig. 29.9b–d). After 3 months the aneurysm was still partly perfused, and within the p64 a minor in-stent stenosis was visible (Fig. 29.10). The 9-month follow-up DSA confirmed the complete occlusion of the AchoA aneurysm, the resolution of the in-stent stenosis, and only a minor residual AV-shunt with the most part of the AVM being obliterated after embolization and radiosurgery (Fig. 29.11).

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© The Author(s) 2019

Authors and Affiliations

  • Hans Henkes
    • 1
  • Marta Aguilar Pérez
    • 1
  1. 1.Neuroradiological ClinicKlinikum StuttgartStuttgartGermany

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