Check how proximal support influences the deployment of a flow-diverting stent
Woman with incidental finding of an aneurysm on examination for meningitis. mRS 0. Inmunodepressed due to treatment for autoimmune hepatitis.
Preparation for the intervention
Seven days before, double antiplatelet therapy was prescribed and started with a loading dose of 300 mg of clopidogrel, followed by 75 mg and 100 mg of acetylsalicylic acid every 24 hours. Liver disease was not considered a contraindication. Platelet aggregation test was not performed.
Volume rendering of the rotational angiography. Bifurcation wide neck and multilobular aneurysm in the middle cerebral artery.
Volume rendering of rotational subtraction angiography. Optimal delivery of the distal end of the Pipeline Vantage device.
MIP reconstruction of the MRI angiographic series. Before the treatment (right) and 6 months after the treatment (left).
Simulation of the stent placement with the Sim & Cure software.
In this case the first treatment option was surgery. It was contraindicated due to comorbidity. For endovascular treatment, embolization with coils or intrasaccular devices does not seem suitable due to the lobulations and wide neck. We opted for the placement of a flow-diverting stent in the thickest M2 branch. Radial access was chosen to minimize puncture complications.
Volume rendering of rotational subtraction angiography. Optimal delivery of the proximal end of the Pipeline Vantage device.
Standard non-subtraction angiography. Optimal delivery of the distal end of the Pipeline Vantage device.
Simple procedure that ends without complications. Good evolution during admission. Discharge 48 hours after the procedure. 8 months later, she remains asymptomatic, the aneurysm is closed in the control with magnetic resonance imaging.
This case is sponsored by Medtronic.
Addressing P1 Occlusion: A Successful Distal Thrombectomy
M1 occlusion with persistent MeVO
Double MeVO treated with Solitaire™ 3 mm