Heit Jeremy J, Telischak Nicholas A, Do Huy M, Dodd Robert L, Steinberg Gary K, Marks Michael P
1 Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University Medical Center, Stanford, CA, USA.
2 Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA.
Interv Neuroradiol. 2017 Dec;23(6):614-619. doi: 10.1177/1591019917722514. Epub 2017 Jul 31.
Background Subarachnoid hemorrhage (SAH) secondary to rupture of a blister aneurysm (BA) results in high morbidity and mortality. Endovascular treatment with the pipeline embolization device (PED) has been described as a new treatment strategy for these lesions. We present the first reported case of PED retraction and foreshortening after treatment of a ruptured internal carotid artery (ICA) BA. Case description A middle-aged patient presented with SAH secondary to ICA BA rupture. The patient was treated with telescoping PED placement across the BA. After 5 days from treatment, the patient developed a new SAH due to re-rupture of the BA. Digital subtraction angiography revealed an increase in caliber of the supraclinoid ICA with associated retraction and foreshortening of the PED that resulted in aneurysm uncovering and growth. Conclusions PED should be oversized during ruptured BA treatment to prevent device retraction and aneurysm regrowth. Frequent imaging follow up after BA treatment with PED is warranted to ensure aneurysm occlusion.
水泡状动脉瘤（BA）破裂继发蛛网膜下腔出血（SAH）会导致高发病率和死亡率。使用管道栓塞装置（PED）进行血管内治疗已被描述为针对这些病变的一种新治疗策略。我们报告首例破裂的颈内动脉（ICA）BA治疗后PED回缩和缩短的病例。病例描述：一名中年患者因ICA BA破裂出现SAH。患者接受了横跨BA的可伸缩PED置入治疗。治疗5天后，患者因BA再次破裂出现新的SAH。数字减影血管造影显示鞍上ICA管径增大，同时伴有PED回缩和缩短，导致动脉瘤暴露和增大。结论：在破裂BA治疗期间，PED应选择过大尺寸以防止装置回缩和动脉瘤再生长。对接受PED治疗的BA进行频繁的影像学随访，以确保动脉瘤闭塞是必要的。
