Department of Neurosurgery, West Virginia University Hospital, Morgantown, West Virginia, USA.
Department of Pathology, West Virginia University Hospital, Morgantown, West Virginia, USA.
J Neurointerv Surg. 2019 May;11(5):e2. doi: 10.1136/neurintsurg-2018-014511.rep. Epub 2019 Feb 13.
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.
一位中年患者出现后循环症状，病因是一个大的偏心基底干动脉瘤。计划的治疗方法是使用 Pipeline Flex 装置进行血流分流，从基底动脉到左侧大脑后动脉进行松散线圈填塞，该治疗方法成功实施。完整的手术过程，包括实时双平面荧光透视，都被数字化记录下来。术后患者症状改善，并于第 1 天出院。术后第 3 天，患者因大量脑室内和蛛网膜下腔出血而发生心脏骤停。怀疑是动脉瘤破裂；然而，尸检显示动脉瘤囊完整。出血归因于靠近动脉粥样硬化斑块的基底动脉远端的一个小的局灶性裂缝。Pipeline 装置可透过裂缝看到。这是一份尸检报告，记录了主干动脉的损伤，而不是动脉瘤，这是血流分流后致命性延迟性蛛网膜下腔出血的原因。
