title: Pipeline Embolization Device as primary treatment for blister aneurysms and iatrogenic pseudoaneurysms of the internal carotid artery.
abstract: BACKGROUND
  Blood blister type aneurysms (BBAs) and pseudoaneurysms create a unique treatment challenge. Despite many advances in open surgical and endovascular techniques, this subset of patients retains relatively high rates of morbidity and mortality. Recently, BBAs have been treated with flow-diverting stents such as the Pipeline Embolization Device (PED) with overall positive results.
  
  
  METHODS
  Four patients presented with dissecting internal carotid artery (ICA) aneurysms treated with the PED (two BBAs presenting with subarachnoid hemorrhage (SAH), two pseudoaneurysms after injury during endoscopic trans-sphenoidal tumor surgery).
  
  
  RESULTS
  Three patients had a successful angiographic and neurological outcome. One patient with a BBA re-ruptured during initial PED placement, again in the postoperative period, and later died. Primary PED treatment involved telescoping stents in two patients and coil embolization supplementation in one patient.
  
  
  CONCLUSIONS
  The PED should be used selectively in the setting of acute SAH. Dual antiplatelet therapy can complicate hydrocephalus management, and the lack of immediate aneurysm occlusion creates the risk of short-term re-rupture. PED treatment for iatrogenic ICA pseudoaneurysms can provide a good angiographic and neurological outcome.
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Nerva
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Morton
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Levitt
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Osbun
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Ferreira
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA Department of Radiology, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
authors.forename: Basavaraj V
authors.initials: BV
authors.lastname: Ghodke
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA Department of Radiology, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D001768:Blister / Q000000981:diagnostic imaging / Q000628:therapy; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome
keywords: Aneurysm; Complication; Flow Diverter; Hemorrhage; Technique