Pipeline SHIELD treatment of left anterior temporal mid M1-aneurysm

Patient

67 year-old female on Xarelto for atrial fibrillation with history of multiple intracranial aneurysms, discovered during workup for right-sided strokes, and concern for multi-lobed 7mm left mid-M1 aneurysm. On DSA, noted that the anterior temporal artery arises from the proximal neck of the aneurysm.

DPipeline SHIELD DeploymentSA: Right ICA

Pipeline SHIELD DeploymentDSA: Left ECA

• Patient presented 1 month later with episode of AMS/slurred speech.
• Briefly patient had been on ASA + Plavix + xarelto until 1/17/23 when she stopped ASA. On arrival to ED the week following, CT/CTP/CTA notable for L BG and anterior temporal strokes with good distal flow beyond stent without significant decrease in cerebral perfusion appreciated.

There is no clear in-stent stenosis. Good wall apposition. There is persistent filling of the aneurysm, but with marked stasis of flow.

There is no clear in-stent stenosis. Good wall apposition. There is persistent filling of the aneurysm, but with marked stasis of flow.

• Triple-therapy cessation potential contributing factor
• Strokes driven by aneurysm pathology