The use of flow-diverter (FD) stents in recent years has positively changed the therapeutic approach to some vascular diseases, especially of certain types of aneurysms. This paper describes the case of a young patient after a major head trauma causing multiple skull fractures. The trauma occasioned two pseudoaneurysms from the A1 segment of the right anterior cerebral artery and from the A2 segment of the left anterior cerebral artery.
Both lesions were treated with two Pipeline devices (ev3, Irvine, CA, USA) in two different sessions. The CT study and angiographic investigations performed in the following month showed a complete resolution of the post-traumatic pseudoaneurysmal lesions.
Although the use of FD stents is described in the literature, particularly in the treatment of selected aneurysms, this paper shows good technical results in the use of these stents in cases of intracranial post-traumatic pseudoaneurysms with clinical improvement.
AmentaPSStrakeRMJabbourPM. Successful treatment of a traumatic carotid pseudoaneurysm with the Pipeline stent: case report and review of the literature. Surg Neurol Int.2012; 3: 160. doi: 10.4103/2152-7806.105099.
3.
LimYCKangJKChungJ. Reconstructive stent-buttressed coil embolization of a traumatic pseudoaneurysm of the supraclinoid internal carotid artery. Acta Neurochir (Wien).2012; 154(3): 477–480. doi: 10.1007/s00701-011-1251-7.
4.
MedelRCrowleyRWHamiltonDK. Endovascular obliteration of an intracranial pseudoaneurysm: the utility of Onyx. J Neurosurg Pediatr.2009; 4(5): 445–448. doi: 10.3171/2009.6.PEDS09104.
5.
Van RooijWJVan RooijSBT. Endovascular treatment of traumatic pericallosal artery aneurysms. A case report. Interv Neroradiol.2013; 19(1): 56–59.
6.
BrigantiFNapoliMTortoraF. Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications – a retrospective data analysis. Neuroradiology.2012; 54(10): 1145–1152. doi: 10.1007/s00234-012-1047-3.
7.
NelsonPKLylykPSzikoraI. The Pipeline embolization device for the intracranial treatment of aneurysms trial. Am J Neuroradiol.2011; 32(1): 34–40. doi: 10.3174/ajnr.A2421.
8.
FernsSPSprengersMEvan RooijWJ. Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke.2009; 40(8): e523–529. doi: 10.1161/STROKEAHA.109.553099.
9.
GeremiaGHaklinMBrenneckeL. Embolization of experimentally created aneurysms with intravascular stent devices. Am J Neuroradiol.1994; 15: 181–184.
10.
SadasivanCCesarLSeongJ. Treatment of rabbit elastase-induced aneurysm models by flow diverters: development of quantifiable indexes of device performance using digital subtraction angiography. IEEE Trans Med Imaging.2009; 28(7): 1117–1125. doi: 10.1109/TMI.2008.2012162.
11.
BenitezRPSilvaMTKlemJ. Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery.2004; 54(6): 1359–1367, discussion 1368. doi: 10.1227/01.NEU.0000124484.87635.CD.
12.
FisherSVajdaZPerez AguilarM. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology.2012; 54(4): 369–382. doi: 10.1007/s00234-011-0948-x.
13.
TragerALSadasivanCSeongJ. Correlation between angiographic and particle image velocimetry quantifications of flow diverters in an in vitro model of elastase-induced rabbit aneurysms. J Biomech Eng.2009; 131(3): 034506. doi: 10.1115/1.3049528.
14.
RadaelliAGAugsburgerLCebralJR. Reproducibility of haemodynamical simulations in a subject-specific stented aneurysm model – a report on the Virtual Intracranial Stenting Challenge 2007. J Biomech.2008; 41(10): 2069–2081. doi: 10.1016/j.jbiomech.2008.04.035.
15.
YeungTWVincentLLauHY. Long-term outcome of endovascular reconstruction with the Pipeline embolization device in the management of unruptured dissecting aneurysms of the intracranial vertebral artery. J Neurosurg.2012; 116(4): 882–887. doi: 10.3171/2011.12.JNS111514.
16.
ConsoliANappiniSRenieriL. Treatment of two blood blister-like aneurysms with flow diverter stenting. J Neurointervent Surg.2012; 4: 3–e4. doi:10.1136/jnis.2010.004572.
17.
MartinARCruzJPMatoukCC. The Pipeline flow-diverting stent for exclusion of ruptured intracranial aneurysms with difficult morphologies. Neurosurgery.2012; 70(1 Suppl 1): ONS21–28. discussion ONS28–29. doi: 10.1227/NEU.0b013e3182315ee3.
18.
KulcsarZWetzelSGAugsburgerL. Effect of flow diversion treatment on very small ruptured aneurysms. Neurosurgery.2010; 67(3): 789–793. doi: 10.1227/01.NEU.0000372920.39101.55.
19.
GriauzdeJGemmeteJJChaudharyN. Basilar artery pseudoaneurysm presenting at 5-month follow-up after traumatic atlanto-occipital dislocation in a 7-year-old girl treated with intracranial stent placement and coiling. J Neurointerv Surg.2014; 6(1): e8. doi: 10.1136/neurintsurg-2012-010573.rep.
20.
Prasad V, Gandhi D, Jindal G. Pipeline endovascular reconstruction of traumatic dissecting aneurysms of the intracranial internal carotid artery. J Neurointerv Surg. 2014; 6(10): e48.
21.
ZanatyMChalouhiNTjoumakarisSI. Flow-diversion panacea or poison?Front Neurol.2014; 28(5): 21. doi: 10.3389/fneur.2014.00021.
22.
Faught RW, Satt SR, Hurst RW, et al. Heterogeneous practice patterns regarding antiplatelet medications for neuroendovascular stenting in the USA: a multicenter survey. J Neurointerv Surg. 2014; 6(10): 774–779.
