Treatment of a Ruptured Vertebrobasilar Fusiform Aneurysm Using Pipeline Embolization Device.
10.7461/jcen.2013.15.1.30
- Author:
Lee A TAN
1
;
Roham MOFTAKHAR
;
Demetrius K LOPES
Author Information
1. Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA. roham_moftakhar@rush.edu
- Publication Type:Case Report
- Keywords:
Fusiform aneurysm;
Ruptured aneurysm;
Subarachnoid hemorrhage;
Therapeutic embolization;
Vertebrobasilar dolichoectasia
- MeSH:
Aneurysm;
Aneurysm, Ruptured;
Aspirin;
Basilar Artery;
Blister;
Cerebral Angiography;
Embolization, Therapeutic;
Follow-Up Studies;
Humans;
Magnetic Resonance Imaging;
Stents;
Subarachnoid Hemorrhage;
Thrombosis;
Ticlopidine;
Vertebral Artery;
Vertebrobasilar Insufficiency
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2013;15(1):30-33
- CountryRepublic of Korea
- Language:English
-
Abstract:
Treatment options of ruptured vertebrobasilar fusiform aneurysms (VFA) are limited and often carry significant mortality and morbidity. We report the use of Pipeline Embolization Device (PED) to successfully treat a patient with a ruptured vertebrobasilar fusiform aneurysm (VFA) who presented with subarachnoid hemorrhage (SAH). A 73 year-old man with a history of cardiac stent placement seven days earlier presented with Hunt-Hess II SAH. He was taking aspirin and clopidogrel. Computed tomography angiogram revealed a large vertebrobasilar fusiform aneurysm. Microsurgical treatment options are technically challenging and carry high risk. He underwent endovascular treatment of the ruptured VFA using overlapping PEDs. Five PEDs were placed in a telescoping fashion to reconstruct the affected portions of the left vertebral and basilar arteries. An additional 2-mm blister aneurysm in the right vertebral artery was also discovered during the conventional cerebral angiography and was treated with one additional PED. The patient remained neurologically intact after the procedure. He was continued on aspirin and clopidogrel. Follow-up magnetic resonance imaging at three months demonstrated patency of the stents without any evidence of ischemic change. Follow-up conventional cerebral angiogram at six months demonstrated thrombosis of the VFA and reconstruction of the vertebrobasilar system. The patient remained clinically well. An endovascular approach using PEDs can be a safe and effective treatment option for ruptured VFA in selected cases.
