Abstract Details

Title Use of Pipeline Flow Diversion in Acute Ruptured Fusiform Anterior Cerebral Artery Aneurysm

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P13 - Poster Session 13 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-011

Objective To report an endovascular strategy in repair of an acute ruptured ACA fusiform aneurysm using PED.

Background Off-label use of PED for unruptured anterior cerebral artery (ACA) has been described in a recent case series. However, there are no reports of primary PED in acute ruptured ACA fusiform aneurysms.

Design/Methods Case report

Results 41-year-old African American male, with history of hepatitis C induced liver failure and complete remission after Harvoni treatment, presented with H&H I subarachnoid hemorrhage (SAH). Angiography demonstrated a 7 mm fusiform aneurysm in the right mid ACA. There was no cross filling of the right A2 shown by angiography of the contralateral internal carotid artery (ICA). After a comprehensive discussion between neuro-endovascular surgery and neurosurgery, aneurysm repair with PED was decided as the only option. Endovascular vessel sacrifice was not an option due to the lack of cross filling. Crushed loading doses of aspirin 324 mg and clopidrogel 300 mg were administered via orogastic tube after intubation. 8F balloon guide catheter was placed in the petrous-ICA. A Phenom-Plus and Phenom Microcatheter were navigated over a Synchro Soft 2 Microcatheter to place the Phenom microcatheter in right A2. The Phenom Plus was engaged to the proximal right A1 for stability and prevention of PED embolization to the middle cerebral artery. Intravenous bolus heparin was administered after the placement of microcatheter. For better flow diversion, two overlapping PED measuring 3 mmx14mm and 3.25 mmx12 mm were successfully implanted covering A2 to A1 without prolapse into ICA or MCA. Patient was discharged home on day 14 with a modified Rankin Scale(mRS) 1 and achieved mRS 0 on day 90. Repeat angiography demonstrated obliteration of the aneurysm.

Conclusions

Pipeline primary flow diversion is a potential option for treatment of a ruptured ACA fusiform aneurysm when no other alternative options are feasible. Further studies are required.

Authors/Disclosures
Yahia M. Lodi, MD, F�鶹��ýӳ�� (Downstate Health Sciences University/OBH-Brookdale University Hospital) PRESENTER	Dr. Lodi has nothing to disclose.
	No disclosure on file
	No disclosure on file

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