E-069 Treatment of intracranial internal carotid pseudoaneurysm and aneurysmal subarachnoid hemorrhage with pipeline shield flow diverter. (23rd July 2022)

• Record Type: Journal Article
• Authors: Abouelleil, M; Lyons, L; Aljaboori, K; Singer, J
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A112
• Page End: A112
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.180
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Summary: We describe the successful management of aneurysmal subarachnoid hemorrhage (SAH) in two patients using Pipeline shield embolization and single antiplatelet therapy. The first patient, a 43-year-old male, developed an iatrogenic supraclinoid internal carotid artery (ICA) pseudoaneurysm after pituitary tumor resection. The second patient had a ruptured left posterior inferior cerebellar artery (PICA) aneurysm. Both aneurysms were successfully treated with Pipeline flex shield embolization device with no intraoperative or perioperative complications. Stent patency was also confirmed 6 months after placement without intra-stent thrombus formation. Our successful experience with the Pipeline flex shield demonstrates the possibility of reducing dual antiplatelet therapy to a single agent in the setting of SAH. Background: The commonly used treatment approaches for ruptured intracranial aneurysms are either endovascular coiling or surgical clipping. 1 The complexity of a considerable population of aneurysms, which can be dictated by shape, size, or location, makes them unamenable to either treatment approach. These aneurysms are usually managed with either stent assisted coiling or flow diverting stents. 2, 3 Despite their promising results, thromboembolism and ischemia are known complications. 4 Although the use of antiplatelet therapy can reduce thrombogenicity, it increases the risk of bleeding, especially in the setting of aneurysmal subarachnoid hemorrhage. Shielded Pipeline stents are flow diverting stents that are coated with phosphorylcholine, an antithrombotic agent that inhibits platelet aggregation and activation. The advent of this technology reduced the risk of thrombotic events compared to 'unshielded' stents. 5 Conclusion: Our presented cases demonstrate the efficacy and safety of Pipeline shield stents, combined with single antiplatelet therapy for 6 months, in the management of aneurysmal SAH. Disclosures: M. Abouelleil: None. L. Lyons: None. K. Aljaboori: None. J. Singer: None.