Pipeline Embolization of an Infectious Basilar Artery Aneurysm in a 2-Year-Old Child: Case Report, Discussion of the Literature and Perioperative Considerations

2019 ◽  
Vol 17 (5) ◽  
pp. E224-E228 ◽  
Author(s):  
William J Ares ◽  
Daniel A Tonetti ◽  
Stephanie Greene ◽  
Mahesh S Sharma ◽  
Frederico Xavier ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Pediatric Population ◽  
Systemic Disease ◽  
Artery Aneurysm ◽  
Flow Diversion ◽  
Channel Blockers ◽  
Orthotopic Heart Transplant ◽  
Medical Comorbidities ◽  
Low Weight ◽  
Made In

AbstractBACKGROUND AND IMPORTANCEFlow diversion of intracranial aneurysms has been rarely described in the pediatric population. Here we discuss the technical and perioperative complexities inherent in the flow diversion of an infectious basilar apex aneurysm in a 2-yr-old child with significant medical comorbidities.CLINICAL PRESENTATIONFollowing judicious oral administration of dual anti-platelet agents and intra-arterial administration of calcium channel blockers to treat vasospasm, standard endovascular procedures were used to place a flow diverting stent across the neck of a rapidly enlarging infectious aneurysm of the basilar apex.Following the uncomplicated procedure, the patient demonstrated progressive thrombosis of the previously noted basilar apex aneurysm over a 3-mo period. The patient was therefore felt to be safe to proceed with, and eventually underwent, uncomplicated orthotopic heart transplant.CONCLUSIONFlow diversion of complex intracranial aneurysms in pediatric patients with significant medical comorbidities is feasible and safe; however, considerations have to be made in the pre- and perioperative care of these patients given the propensity for low-weight and complicated systemic disease processes.

scholarly journals Flow diversion for complex intracranial aneurysms in young children

2015 ◽  
Vol 15 (3) ◽  
pp. 276-281 ◽  
Author(s):  
Ramon Navarro ◽  
Benjamin L. Brown ◽  
Alexandra Beier ◽  
Nathan Ranalli ◽  
Philipp Aldana ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Open Surgery ◽  
Pediatric Population ◽  
Artery Aneurysm ◽  
Flow Diversion ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Primordial Dwarfism ◽  
Vessel Response ◽  
Posterior Communicating Artery Aneurysm

Pediatric intracranial aneurysms are exceedingly rare and account for less than 5% of all intracranial aneurysms. Open surgery to treat such aneurysms has been shown to be more durable than endovascular techniques, and durability of treatment is particularly important in the pediatric population. Over the past 2 decades, however, a marked shift in aneurysm treatment from open surgery toward endovascular procedures has occurred for adults. The authors describe their early experience in treating 3 unruptured pediatric brain aneurysms using the Pipeline embolization device (PED). The first patient, a girl with Majewski osteodysplastic primordial dwarfism Type II who was harboring multiple intracranial aneurysms, underwent two flow diversion procedures for a vertebrobasilar aneurysm and a supraclinoid internal carotid artery aneurysm. The second patient underwent PED placement on a previously coiled but enlarging posterior communicating artery aneurysm. All procedures were uneventful, with no postsurgical complications, and led to complete angiographic obliteration of the aneurysms. To the authors' knowledge, this is the first series of flow diversion procedures in children reported in the medical literature. While flow diversion is a new and relatively untested technology in children, outcomes in adults have been promising. For challenging lesions in the pediatric population, flow diversion may have a valuable role as a well-tolerated, safe treatment with durable results. Many issues remain to be addressed, such as the durability of flow diverters over a very long follow-up and vessel response to growth in the presence of an endoluminal device.

Ruptured Mycotic Aneurysm of the Distal Circulation in a Patient with Mucormycosis Without Direct Skull Base Extension: Case Report

2018 ◽  
Vol 16 (3) ◽  
pp. E101-E107 ◽  
Author(s):  
Shivani D Rangwala ◽  
Ben A Strickland ◽  
Robert C Rennert ◽  
Kristine Ravina ◽  
Joshua Bakhsheshian ◽  
...  
Keyword(s):  
Skull Base ◽  
Intracranial Aneurysms ◽  
Systemic Disease ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Pathological Examination ◽  
Unknown Etiology ◽  
Intracranial Surgery ◽  
Pulmonary Mucormycosis ◽  
Base Extension

Abstract BACKGROUND AND IMPORTANCE Infectious intracranial aneurysms are a rare subset of intracranial aneurysms caused by bacterial, fungal, or viral sources. Intracranial aneurysms of fungal etiology carry a high mortality risk and typically occur in immunocompromised patients via direct extension of skull base infections, or more rarely, after intracranial surgery. CLINICAL PRESENTATION We present the case of a 27-yr-old female with systemic lupus erythematous and primary pulmonary mucormycosis, who suffered a subarachnoid hemorrhage from a ruptured fusiform distal middle cerebral artery aneurysm. Despite undergoing a successful extracranial-to-intracranial bypass and aneurysm excision, the patient ultimately died following progressive disseminated infection and a secondary intracranial hemorrhage of unknown etiology. Pathological examination of the excised artery confirmed Mucor infection. CONCLUSION To the best of our knowledge, this case represents one of the first mycotic cerebral aneurysms from mucormycosis in a patient without an underlying skull base infection or previous intracranial surgery. Despite optimal surgical management, clinical outcomes for mycotic cerebral aneurysms are largely dependent on the success of medical therapies at controlling systemic disease.

Republished: Infantile intracranial aneurysm of the superior cerebellar artery

2016 ◽  
Vol 8 (12) ◽  
pp. e50-e50 ◽  
Author(s):  
Molly Ann Del Santo ◽  
Steve Mario Cordina
Keyword(s):  
Intracranial Aneurysms ◽  
Pediatric Population ◽  
External Ventricular Drain ◽  
Artery Aneurysm ◽  
Definitive Treatment ◽  
Superior Cerebellar Artery ◽  
Treatment Results ◽  
Endovascular Technique ◽  
Ct Angiogram ◽  
Cerebellar Artery

Intracranial aneurysms in the pediatric population are rare. We report a case of a 3-month-old infant who presented with inconsolable crying, vomiting, and sunset eye sign. CT revealed a subarachnoid hemorrhage, with CT angiogram revealing a superior cerebellar artery aneurysm. An external ventricular drain was placed for acute management of hydrocephalus, with definitive treatment by endovascular technique with a total of six microcoils to embolize the aneurysm. Serial transcranial Dopplers revealed no subsequent vasospasm. Although aneurysms in the pediatric population are rare, once the diagnosis is established, early treatment results in better outcomes.

scholarly journals Endovascular Treatment of a Ruptured Distal Anterior Cerebral Artery Aneurysm Using Coils and N-Butyl-Cyanoacrylate in a 5-Month-Old Baby

2021 ◽  
Vol 5 (01) ◽  
pp. 55-58
Author(s):  
Giancarlo Saal-Zapata ◽  
Jesús Flores ◽  
Ricardo Vallejos ◽  
Dante Valer ◽  
Walter Durand ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Intracranial Aneurysms ◽  
Pediatric Population ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
Dissecting Aneurysm ◽  
Anterior Cerebral Artery Aneurysm ◽  
Distal Anterior Cerebral Artery ◽  
Cerebral Artery Aneurysm ◽  
Ruptured Intracranial Aneurysms

AbstractIntracranial aneurysms in pediatric population are rare and differ in several features with their adult counterpart. Clipping and endovascular therapy have both demonstrated favorable clinical outcomes with reconstructive and deconstructive techniques. We present the case of a 5-month-old infant who was admitted to the emergency with interhemispheric and sylvian subarachnoid hemorrhage. CT angiography and three-dimensional digital subtraction angiography revealed a ruptured left pericallosal aneurysm with morphological features of a dissecting aneurysm. Coiling and N-butyl-cyanoacrylate administration were employed to occlude the aneurysm without complications. Endovascular therapy is an effective and safe option in cases of ruptured intracranial aneurysms in pediatric patients with favorable clinical and radiological outcomes.

Thromboelastography (TEG) results are predictive of ischemic and hemorrhagic complications in patients with unruptured intracranial aneurysms treated with flow diversion

2021 ◽  
pp. 159101992110259
Author(s):  
Kainaat Javed ◽  
Santiago R Unda ◽  
Ryan Holland ◽  
Adisson Fortunel ◽  
Rose Fluss ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Aneurysms ◽  
Statistical Significance ◽  
Alpha Angle ◽  
Flow Diversion ◽  
P Value ◽  
Hemorrhagic Complication ◽  
Unruptured Intracranial Aneurysms ◽  
Hemorrhagic Complications ◽  
Groin Hematoma

Introduction Flow diversion is an effective treatment modality for intracranial aneurysms but is associated with ischemic and hemorrhagic complications. Patients treated with flow diversion require dual antiplatelet therapy and subsequent platelet function tests. At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is the test of choice. The primary objective of this study was to identify TEG parameters that are predictive of postoperative complications in patients treated with elective flow diversion. Methods This was a retrospective study of 118 patients with unruptured intracranial aneurysms treated with flow diversion. Data was collected via chart review. Bivariate analyses were performed to identify significant variables in patients who suffered an ischemic stroke or a groin hematoma. ROC curves were constructed for the TEG parameters with statistical significance. Bivariate analyses were repeated using dichotomized TEG results. Results Patients who experienced a symptomatic ischemic stroke had a history of stroke (p value = 0.007), larger aneurysm neck width (p value = 0.017), and a higher alpha angle (p value = 0.013). Cut off point for ischemic complication is 63° on ROC curve with a sensitivity of 100% and specificity of 65%. Patients who experienced a groin hematoma were no different from their healthy peers but had a lower alpha angle (p value = 0.033). Cut off point for hemorrhagic complication is 53.3° with a sensitivity of 82% and specificity of 67%. Conclusion The Alpha Angle parameter of TEG-PM has a sizeable predictive ability for both ischemic complications of the central nervous system and hemorrhagic complications of the access site after elective flow diversion.

Outcomes following aneurysmal coil embolization with intentionally shortened low-profile visible intraluminal support stent deployment

2021 ◽  
pp. 197140092110269
Author(s):  
Kenji Yatomi ◽  
Yumiko Mitome-Mishima ◽  
Takashi Fujii ◽  
Kohsuke Teranishi ◽  
Hidenori Oishi ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Perioperative Complications ◽  
Flow Diversion ◽  
Stent Deployment ◽  
Coverage Ratio ◽  
Low Profile ◽  
Unruptured Intracranial Aneurysms

Purpose Among all stents available for neuroendovascular therapy, the low-profile visible intraluminal support stent bears the highest metal coverage ratio. We deployed a low-profile visible intraluminal support stent with a delivery wire or/and microcatheter system push action to shorten the low-profile visible intraluminal support stent and thus achieve a flow diversion effect. We report our single-institution experience with the use of low-profile visible intraluminal support stents for intentionally shortened deployment (shortening group) and non-shortened deployment (non-shortening group) for unruptured intracranial aneurysms. Methods We retrospectively reviewed the medical records of 130 patients with 131 intracranial aneurysms who were treated with low-profile visible intraluminal support stent-assisted coil embolization from February 2016–January 2019. All perioperative complications were noted. Every 6 months, we re-examined the patients with cerebral angiography or magnetic resonance angiography. The outcomes of aneurysm occlusion were evaluated by the modified Raymond–Roy occlusion classification. We used the finite element method and computational fluid dynamics to investigate the hemodynamics after shortened low-profile visible intraluminal support stent deployment. Results Immediately after treatment, the modified Raymond-Roy occlusion classification was significantly better in the shortening group than in the non-shortening group ( p<0.05). The latest angiographic outcomes showed the same tendency. Hemodynamic analysis by computational fluid dynamics suggested an adequate flow diversion effect with the use of our intentional shortening method. Conclusions Stent-assisted coil embolization using this technique showed good results of a high complete occlusion rate and low complication rate. These findings suggest that shortened low-profile visible intraluminal support stent deployment yields a flow diversion effect and may lead to early intra-aneurysmal thrombus formation.

Optical coherence tomography for elucidation of flow-diversion phenomena: The concept of endothelized mural thrombus behind reversible in-stent stenosis in flow-diverters

2021 ◽  
pp. 159101992110034
Author(s):  
Andre Monteiro ◽  
Demetrius K Lopes ◽  
Amin Aghaebrahim ◽  
Ricardo Hanel
Keyword(s):  
Optical Coherence Tomography ◽  
Intracranial Aneurysms ◽  
Flow Diversion ◽  
Optical Coherence ◽  
Recurrence Rates ◽  
Oct Imaging ◽  
Intravascular Optical Coherence Tomography ◽  
Stenotic Area ◽  
Flow Diverters ◽  
Stent Stenosis

Purpose Flow-diverters have revolutionized the endovascular treatment of intracranial aneurysms, offering a durable solution to aneurysms with high recurrence rates after conventional stent-assisted coiling. Events that occur after treatment with flow-diversion, such as in-stent stenosis (ISS) are not well understood and require further assessment. After assessing an animal model with Optical Coherence Tomography (OCT), we propose a concept that could explain the mechanism causing reversible ISS after treatment of intracranial aneurysms with flow-diverters. Methods Six Pipeline Flex embolization devices (PED-Flex), six PED with Shield technology (PED-Shield), and four Solitaire AB devices were implanted in the carotid arteries (two stents per vessel) of four pigs. Intravascular optical coherence tomography (OCT) and digital subtraction angiography (DSA) images obtained on day 21 were compared to histological specimens. Results A case of ISS in a PED-Flex device was assessed with OCT imaging. Neointima with asymmetrical topography completely covering the PED struts was observed. Histological preparations of the stenotic area demonstrated thrombus on the surface of device struts, covered by neointima. Conclusion This study provides a plausible concept for reversible ISS in flow-diverters. Based on an observation of a previous experiment, we propose that similar cases of ISS are related to thrombus presence underneath endothelization, but further experiments focused on this phenomenon are needed. Optical Coherence Tomography will be useful tool when available for clinical use.

Intracranial aneurysms in pediatric population: a two-center audit

2021 ◽  
Author(s):  
Elisabeth Garrido ◽  
Thomas Metayer ◽  
Alin Borha ◽  
Olivier Langlois ◽  
Sophie Curey ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Pediatric Population

scholarly journals An autopsy report of basilar artery aneurysm flow diversion complicated by postoperative day 3 hemorrhage from vessel rupture

2018 ◽  
Vol 11 (1) ◽  
pp. e014511 ◽  
Author(s):  
Azeem A Rehman ◽  
Ryan C Turner ◽  
Stephanie Wright ◽  
SoHyun Boo ◽  
Ansaar T Rai
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Basilar Artery ◽  
Artery Aneurysm ◽  
Symptomatic Improvement ◽  
Aneurysm Rupture ◽  
Flow Diversion ◽  
Atheromatous Plaque ◽  
Parent Artery ◽  
Autopsy Report ◽  
Complete Procedure

A middle-aged patient presented with posterior circulation symptoms attributable to a large eccentric basilar trunk aneurysm. The planned treatment was flow diversion with loose coil packing which was successfully performed using a Pipeline Flex device deployed from the basilar to the left posterior cerebral artery. The complete procedure including live biplane fluoroscopy was digitally recorded. The patient had symptomatic improvement postoperatively and was discharged on day 1. The patient suffered a cardiac arrest on postoperative day 3 secondary to massive intraventricular and subarachnoid hemorrhage. An aneurysm rupture was suspected; however, postmortem examination showed an intact aneurysm sac. The hemorrhage was attributed to a small focal rent in the distal basilar artery next to an atheromatous plaque. The Pipeline device was visible through the rent. This is an autopsy report documenting an injury to the parent artery and not the aneurysm as a source of fatal delayed subarachnoid hemorrhage following flow diversion.

Rerupture of a Blister Aneurysm After Treatment With a Single Flow-Diverting Stent

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. E634-E638 ◽  
Author(s):  
Marcus D. Mazur ◽  
Philipp Taussky ◽  
Joel D. MacDonald ◽  
Min S. Park
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Successful Treatment ◽  
Internal Carotid ◽  
Case Reports ◽  
Treatment Strategies ◽  
Artery Aneurysm ◽  
Flow Diversion ◽  
Multiple Treatment ◽  
Internal Carotid Artery Aneurysm

Abstract BACKGROUND AND IMPORTANCE: As the use of flow-diverting stents (FDSs) for intracranial aneurysms expands, a small number of case reports have described the successful treatment of blister aneurysms of the internal carotid artery with flow diversion. Blister aneurysms are uncommon and fragile lesions that historically have high rates of morbidity and mortality despite multiple treatment strategies. We report a case of rebleeding after treatment of a ruptured blister aneurysm with deployment of a single FDS. CLINICAL PRESENTATION: A 29-year-old man presented with subarachnoid hemorrhage and a ruptured dorsal variant internal carotid artery aneurysm. Despite a technically successful treatment with a single FDS, a second catastrophic hemorrhage occurred during the course of his hospitalization. CONCLUSION: This case highlights the risk of hemorrhage during the period after deployment of a single FDS. Ruptured aneurysms, especially of the blister type, are at risk for rehemorrhage while the occlusion remains incomplete after flow diversion.

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