Use of Pipeline™ embolization device for the treatment of traumatic intracranial pseudoaneurysms: Case series and review of cases from literature

Mairaj T. Sami, Domenico A. Gattozzi, Hesham M. Soliman, Alan R. Reeves, Christopher J. Moran, Paul J. Camarata, Koji C. Ebersole

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Objective: Intracranial traumatic pseudoaneurysms (PSA) are a rare but dangerous subtype of cerebral aneurysm. Reports documenting use of flow-diverting stents to treat traumatic intracranial PSAs are few and lack long-term follow-up. To our knowledge, this is the largest case-series to date demonstrating use of Pipeline Endovascular Device (PED) for traumatic intracranial PSAs. Patients and Methods: Retrospective review of 8 intracranial traumatic PSAs in 7 patients treated using only PED placement. Patients were followed clinically and angiographically for at least 6 months. Results: Seven patients with a mean age of 37 years were treated for 8 intracranial pseudo-aneurysms between 2011–2015. Six aneurysms were the result of blunt trauma; 2 were from iatrogenic injury during transsphenoidal surgery. Mean clinical and angiographic follow-up in surviving patients was 15.2 months. In patients with angiographic follow-up, complete occlusion was achieved in all but one patient, who demonstrated near-complete occlusion. No ischemic events or stent-related stenosis were observed. One patient developed a carotid-cavernous fistula after PED, which was successfully retreated with placement of a second PED. There were two mortalities. One was due to suspected microwire perforation remote from the target aneurysm resulting in SAH/IPH. The other was due to a traumatic SDH and brainstem hemorrhage from an unrelated fall during follow-up interval. Conclusions: Use of PED for treatment of intracerebral PSAs following trauma or iatrogenic injury showed good persistent occlusion, and acceptable complication rate for this high-risk pathology. Risks of this procedure and necessary antiplatelet therapy require appropriate patient selection. Larger prospective studies are warranted.

Original languageEnglish
Pages (from-to)154-160
Number of pages7
JournalClinical Neurology and Neurosurgery
Volume169
DOIs
StatePublished - Jun 2018

Keywords

  • Iatrogenic
  • Internal carotid artery (ICA)
  • Pipeline™ embolization device (PED)
  • Pseudoaneurysm (PSA)
  • Skull Base fracture
  • Subarachnoid hemorrhage (SAH)
  • Trauma

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